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Full text of "Harvard medical alumni bulletin"

WINTER 2002 




i 



1 



ALUMNI BULLETI 


















*$. 



When doctors and 
patients just don't mix 





■ ■ .-■• ■■■■ .- 







-*K 





1 


.UMINARY 














Francis D. Moore (1 91 3-2001 ) 
helped train more than 1 ,500 
surgeons during a career cele- 
brated for scientific accomplish- 
ment and outstanding ethics. 





WINTER 2002 • VOLUMI 75, \ I M I! E R 3 



CONTENTS 




DEPARTMENTS 



Letters 3 

Pulse 8 

New hospital presidents at the helm; 
shared tools for learning and research at 
HMS, a new dean for diversity 

President's Report 10 

by Paul J. Davis 

Bookshelf 11 

Benchmorks 12 

Fruit fly fights; the knowing nose; 
circadian clock clues; points of pain 
and pleasure 

Class N otes 54 

InMemoriam 59 

Francis D. Moore 

InMemoriam 60 

John R. Brooks 

Obituaries 61 



BAD CHEMISTRY: WHEN DOCTORS AND PATIENTS JUST DON'T MIX 



Silent Treatment 16 

What happens when physicians don't care for the patients 
they're caring for? 

b\ RAF A E L C A M P O 



Everybody Hates Raymond 

Some patients inspire doctors to swear 
oaths less than Hippocratic. 

h\ E LI S S A ELY 



Ire Fighters 

Physicians can learn to respond effectively when patients 
lose their patience. 

/'\ | O 11 N G . GUNDERSON 




Tell Me the Worst, Doctor 

Harvard trained physicians recall some oi their trickiest 
clinical encounters. 



32 



nsEoa 

Special Operations 



36 




A surgeon trained in the secret maneuvers of the 
CIA recounts his role in the Korean War. 

by IHOMAS G. PARKER 

Ground Zero 42 

A member of one of the Disaster Medical Assistance 
Teams deployed to New York reflects on the despair — 
and lessons — of the September 11 tragedy. 

by | A Y | . S C H N I T Z E R 

Built to Last 46 

In the marble splendor of Building A, the 
sixth administrative home of Harvard 
Medical School has proved to be enduring. 

f)V NORA N. NERCESSIAN 



( over illustration by James O'Brien 



Har va r d M edical 



ALUMNI 



U L L E T I N 




In This Issue 

MPATHY HAS A BAD NAME. THE SOUND ITSELF IS GOOEY, FLABBY. AS A 

word it keeps unsavory company. "See Synonyms at pity," says my 
dictionary — "pity" in boldface. The reality is that empathy is a job 
for the head over the heart. It requires intellectualization, imagi- 
nation, and some experience of life. It is a skill as much as an attribute. And 
with the best of intentions, it is a skill that fails us from time to time. In this 
issue, several of our contributors reflect on encounters that test or defeat a 
physician's ambition to empathize. 

One of the chief barriers to learning and practicing empathy is the tendency 
to sentimentalize it. Empathy is a mental tool, as useful to con artists as to 
counselors. The character of Counselor Deanna Troi in the TV series "Star 
Trek: The Next Generation" is a particularly irritating example of empathy 
turned to treacle. The psychiatrist Jennifer Melfi, carefully treating the Mafioso 
Tony Soprano, sets a better example, on the whole, of dispassionate empathy. 
So, for that matter, does Hannibal Lecter, the ultimate combination of astute 
psychiatrist and absolute sociopath. 

Not quite paradoxically, one's own emotions — fear, for example — can 
become traps along the way to empathy. Understandably, there's nothing like 
the beha-rior of a threatening patient to shut down one's curiosity about the 
mental processes behind the activity. Regrettably, a rapid effort to contain or 
restrain the frightening person can often make the situation worse. And mere 
anger in a patient can be daunting enough. As a person with chronically rising 
gorge and dudgeon set permanently on high, I find that anger in patients is 
always a test of my ability Co tolerate both their feelings and my own for long 
enough to think through the problem, whatever it may be. 

Even when we are armed with self- awareness and liberated from unruly 
emotions of our own, certain patients may defy our best efforts to get what 
they are about. Intoxicated patients leave me clueless, perhaps because they are 
not, in fact, themselves. Vivid memories of childhood fevers, on the other hand, 
give me some sense of what delirium is like. And yet there are people who are 
neither intoxicated nor delirious, but living in a mental place where empathy 
seems impossible. Perhaps the greatest literary illustration is Herman 
Melville's tragic Bartleby a disabled scrivener for whom compassion, though 
abundant, is useless because, willy-nilly, he makes empathy impossible. 

Missing in this issue are the voices of patients. The point of view is the 
physician's. This is because, like doctors, publications cannot be all things to all 
people. In this issue, then, we offer some modest attempts to note the limits of 
our efforts and ability to be perfect physicians. 



EDITOR-IN-CHIEF 

William Ira Bennett '68 

EDITOR 

Paula Brewer Byron 

ASSOCIATE EDITOR 

Beverly Ballaro, PhD 

ASSISTANT EDITOR 

Susan Cassidy 

BOOK REVIEW EDITOR 

Elissa Ely '88 



EDITORIAL BOARD 

Judy Ann Bigby 78 
Rafael Campo '92 

Elissa Ely '88 

Atul Gawande '94 

Robert M. Goldwyn '56 

Perri Klass '86 

Victoria McEvoy 75 

James J. O'Connell '82 

Nancy EOriol 79 

J. Gordon ScanneU '40 

Eleanor Shore '55 

John D. Stoeckle '47 



DESIGN DIRECTOR 

Laura McFadden 



ASSOCIATION OFFICERS 

Paul J. Davis '63, president 
Mitchell T. Rabkin '55, president-elect 1 
Eve J. Higginbotham 79. president-elect 2 

Paula A.Johnson '85, vice president 
Maria C. .Alexander- Bridges '80. secretary 



COUNCILLORS 

Rafael Campo '92 

Barbara J. McNeil '66 

Gina T. Moreno-John '94 

De\\ ayne M. Pursley '82 

Laurence J. Ronan '87 

\ lark L. Rosenberg 72 

Nanette Kass W'enger '54 

Francis C. Wood, Jr. '54 

Kathryn A. Zufall-Larson 75 

DIRECTOR OF ALUMNI RELATIONS 

Daniel D. Federman '53 

ASSISTANT DEAN FOR ALUMNI 
AFFAIRS AND SPECIAL PROJECTS 

Nora N. Xercessian, PhD 

REPRESENTATIVE TO THE 
HARVARD ALUMNI ASSOCIATION 



Joseph K. Hurd '64 



i]^ 



Any [/[a 




The Harvard Medical Alumni Bulletin is 

published quarterly at 25 Shattuck Street. 

Boston. MA 02115 by the Harvard 

Medical Alumni Association. 

Phone (617) 3S4 B900 . Fax: (617) 384 8901 

Email: bulletin^hms. harvard.edu 

Third class postage paid at Boston, 

Massachusetts. Postmaster; send form 3579 

to 25 Shattuck Street. Boston. MA 02115 

ISSN 0191 7757 • Printed in the U.S A 



HARVARD MEDICA1 ALUMNI BULLETIN • WINTER 2002 



SECOND OPINIONS FROM OUR READERS 



LETTERS 






DOCTORS ON PARADE 

certainly enjoyed the Summer 2001 issue of the Bulletin with 
the cover photograph of our classmates in Army uniform. I 
recognized many of the student- soldiers, including Steve 
Deckotf. Ward Orrahood, Frank Egloff, Bruce Fisher, John 
Gray. Loomis Bell, and John Wiggin. I was ninth in line for 
whatever it was we were being served. The photo was taken in 1944 
when we were in the latter part of our first year and most of us were 
between 19 and 21 years old. I don't recall the specific occasion of 
our being fed from the Army truck, but I remember well the weekly 
"parades" when we marched in front of Building A, many ot us out of 
step. We were a pretty sorry bunch of soldiers and Major Rosengard had 
the impossible task of getting us to "shape up." 

The photograph includes only those of us who were in the Army Stu- 
dent Training Program, which was about half of our class. We were envi- 
ous of those who were in the Navy V 12 Program. They wore handsome 
midshipman-type uniforms and had a more relaxed military lifestyle. 

All of us, however, were aware of how fortunate we were to be in the 
protective environment of HMS while many of our college classmates 
were risking their lives to defend our country. This led to our becoming 
the close knit group that still exists. 

Incidentally, most ot us eventually served as medical officers in the 
Army and Navy during the Korean conflict. We were proud to have 
that opportunity to pay, in a small way, our debt of gratitude for the 
safety and happy times we had enjoyed at HMS during the World 
War II years. 

Thank you for including the Class of '47 in your most interesting issue. 

JAMES M. DAVIS '47 
JACKSONVILLE, FLORIDA 



Silent Heroes 

I enjoyed the summer issue of the Bulletin, 
"What Did You Do in the War, Doctor?" 
It was particularly meaningful because I 
am in the process of writing an answer to 
that question for my grandchildren. For 
many years I was unable to talk about my 
experiences, as were many veterans. 

Almost half of my medical school class- 
mates were at least 28 years old. Many of 
us had made the deliberate choice to put 
medical school on hold in order to serve in 
the war. Many had seen combat. We were 
older, seemed different somehow, and 
rarely spoke m the first person. One ex- 
Marine, for example, was reluctant to tell 
about the horrors he had endured. Yander 
bilt Hall was full ol vague allusions but not 
many details: Did you know that so-and-so 
was a Marine at Guadalcanal? That so- 
and-so was a fighter pilot off a carrier? 
That so-and-so came out a full coloneP 

One of the statements that Bill 
McDermott '42 made in that issue — "We 
weren't heroes at all. We were just doing 
what was right and what had to be 
done" — was exactly right. We who were 
lucky and blessed to come back didn't 
feel like heroes. Those who didn't make it 
were the real heroes. 

SHELDON M. LEVIN "50 

SAN FRANCISCO, CALIFORNIA 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



LETTERS 



SECOND OPINIONS FROM OUR READERS 




Photographic Memory 

You may be interested to know that the 
lead student in uniform in the photo of 
students participating in a chemical 
warfare drill is E. Langdon Burwell '44, 
who passed away in 1993. 

JONATHAN B. HORRELL '44 
OAKLAND, CALIFORNIA 



The Forgotten War 

May I compliment you on the special 
report, "What Did You Do in the War, 
Doctor?" The report was especially time- 
ly in view of the events of September 11. 

Fd like to add a few words about action 
in the China-Burma-India theater, which 
has sometimes been described as the "for- 
gotten war." Having been a surgeon with 
the U.S. Army 22nd Field Hospital in 
China from 1943 to 1945, 1 humbly believe 
that our experiences in China must be 
remembered in view of political, social, 
medical, and military considerations. 

I went to China as part of a U.S. Army 
contingent of 750 officers sent over to train 
Chinese forces. When I enlisted, I was only 
25 years old, barely out of HMS, so I 
brought all my medical and surgical text- 
books with me. Of course, we didn't have 
all the fancy equipment commonly used at 
Peter Bent Brigham Hospital available to 
us at the front, so we really had to sharpen 
our skills in the art of taking a thorough 
history and doing a very rigorous physical 
examination — skills that would prove 
useful to me in my postwar Chilian career. 



When my unit was called lor active field 
duty as a portable surgical hospital, we 
traveled toward the front lines almost 
entirely on foot. Walking up to ten hours a 
day over narrow, rough trails, we climbed 
mountains that took five days to ascend 
and relied on wooden-saddled pack ani- 
mals to transport our Limited supplies. We 
set up our first operating room under a 
clump of trees on a sandy riverbank, where 
we carried out one major surgery after 
another, eschewing operating gowns and 
saving precious gloves for abdominal, 
brain, and thoracic procedures. 

After several days, we crossed the river 
to follow our fighting units. We moved 
through monsoon-swollen streambeds 
and over paths so high that we found our- 
selves above the clouds — our lungs felt as 
though they were splitting apart. While 
the Chinese soldiers displayed amazing 
endurance, even carrying loads of our 
equipment on their backs when the going 
got too steep for the animals, most of the 
Americans lost 10 to 20 pounds. 

We eventually set up our hospital in a 
Chinese nunnery, where our carpenter 
transformed a place of worship into a 
crude operating room. To the tall pillars 
supporting the roof we nailed boards 
from which we hung bottles of intra 
venous fluids. In addition to soldiers, 
many civilian victims of the fighting 
passed through our wards. The peasants 
refused to abandon their rice paddies and 
livestock and often found themselves in 




the path of stray Japanese bullets or even 
friendly fire. I remember operating on 
one woman in particular who had been 
shot in the thigh and whose one-year-old 
baby had been hit in the knee. 

.Although decades have passed, I will 
never forget caring for the wounded dur- 
ing the Salween Offensive, when I saw the 
lethally injured die, observed their bodies 
being buried near the Salween River, then 
watched those bodies being washed 
downstream by the swollen, roaring 
water. Xor will I ever forget my experi- 
ences at the front at Tenchung, where 
2,600 Japanese were killed. 

But, as horrific and tragic as the conse- 
quences of war are, we should heed the 
lessons of Pearl Harbor and September 11: 
in peace, as in war, it is always crucial to 
know the enemy and to be prepared. 

WESLEY L. FURSTE, II 41 
COLUMBUS, OHIO 

Articles of War 

I always get a charge out of pieces on 
Harvard during World War II, such as 
the excellent articles in the Summer 2001 
issue. I applied to medical school in 1966 
while on active duty in the Navy. When I 
wrote for a Harvard application I was 
politely told that Harvard did not accept 
applications from indi\iduals on active 
duty. Makes you proud, doesn't it? 

WILLIAM R. WELCH. MD 
BOSTON, MASSACHUSETTS 



HUMBLE HERO 

I knew William McDermott '42 when he 
was an iconic figure in the great HMS 
Surgical Service at Boston City Hospi 
tal. I concur with Editor-in-Chief 
William Bennett's respectful disagree- 
ment with Dr. McDermott's statement 
that he and the other soldiers weren't 
heroes at all, but were just doing what 
had to be done. 

YELANDY MANOHAR, MD 
HADDAM, CONNECTICUT 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 




THE HEART OF THE MATTER 

our interesting summer issue on World War II brought to 
mind the amazing wartime story of one of my HMS classmates, 
Douglas Stone '37. In 1944, during the Normandy campaign in 
World War II, Dr. Stone and his surgical team performed success- 
ful open heart surgery to repair a seriously damaged, lacerated 
heart in an injured soldier. Operating in a muddy, abandoned German tank pit 
amid ferocious battle conditions, Dr. Stone and his team managed to save the 
graveh' wounded soldier. The patient was not breathing, had no pulse, and had 
a wound of the upper right chest that had been stuffed with a piece of GI rain- 
coat to prevent the sucking action. I thought your readers might be interested 
in an abbreviated account, in Dr. Stone's own words, of that dramatic surgery. 

ALBERT ENGLAND - ^7 
LINCOLN, MASSACHUSETTS 




Miracle at Normandy 

The patient was unable to breathe on 
his own. Our anesthetist immediately 
applied a mask to the patient and began 
artificial respiration, which also helped to 
inflate the remaining functional lung, the 
other having collapsed. Simultaneously, 
one of the technicians swabbed the chest 
wall with antiseptic solution, then 
soaked his hands and became our instru- 
ment man. I quickly threw four sterile 
tow els around the wound site and made 
an incision directly through the skin 
wound. It was necessary to rapidly 
remove sections of lour ribs to give myself 
room in which to operate. 

The chest ca\ itv was full of blood, and I 
had to hail it out by the handful. Our tech- 
nicians got the suction working, which 
allowed me to see the damaged area. They 
were unable to insert needles into the col- 
lapsed peripheral veins to give the crucial 
blood and electrolyte fluids. I told them to 
remove the blood pressure cuff from the 
patient's arm and to wrap it around the 
blood donor bag. This improvisation was in 
anticipation of the need to force the blood 
steadily through the tube into the heart. 

By this time, I had the heart exposed 
and moved gently to the patient's right. 
The critical wound was an elongated ver 
tical gash into the right ventricle, now 
barely oozing blood. I plugged the gash 
with my right index finger along the 
wound and, while holding the flaccid 
heart in the same hand, gently massaged it. 
With my left hand I took the large donor 
needle from the technician, having to 



ignore the "sterile" technique, and inserted 
it into the right atrial chamber of the 
heart. Three liters or more of blood were 
given as rapidly as possible. The effect was 
magical. Veins grew \isible in the arms, 
and more blood was started in them. 

With my linger still plugging the deep 
gash, I took a large, curved Bloodgood 
suture needle in the left hand, passed it 
deep through the full thickness ol the 
heart muscle on one side ol the gash, 
under and around my linger and out 
through the full thickness of the heart 
muscle on the other side. This was done 
quickly lour times in a row Then, as I slid 
vci) Linger out, mj assistant gently pulled 
up all tour sutures, I quickly tied square 
knots in each suture one by one, snugly, 
but not tightly. Over this incision I 
sutured a flap of pericardium to cover and 
support the closure. The sac itself was not 
fully closed for fear a possible accumula 
tion of blood into the empty sac might 
compress the heart and inhibit its action 
or cause localized infection. 

After closure of the heart wound had 
been completed, I resumed cardiac mas- 
sage to the flaccid heart muscle and could 
feel it perceptibly firming up and fibrillat 
ing. Soon a little rhythm or beat was 
detectable. As I continued this action, the 
patient began to change color from paper 
white to pale pink. His wins were fillin g 
up, so now the)' could be used to give 
additional blood more rapidly. We all gave 
a heartfelt sigh of relief. We knew we had 
won the all-important first round. 



By now all bleeding had stopped. The 
patient had received and retained an 
estimated five liters of whole blood, 
was showing an even better color, and 
had a detectable pulse. Finally, we 
checked around the chest cavity for 
"bleeders," using the suction apparatus 
to empty all fluid and to get a "dry" 
chest. A couple of hemastatic sutures 
w ere quickly placed in a shallow lacer 
ation ol the right lung. We then insert 
ed our drains through stab wounds into 
the chest cavity, instilled 40,000 units 
of penicillin into the chest, sprinkled 
sulfanilamide powder into the chest 
and tissues, and carefully closed the 
incision in layers. 

In 1995, while my wife, Essie, and I 
were on an automobile trip through the 
West, we made a search for the patient, 
Terry, and found him in his comfortable- 
home in Iowa. He was doing well at age 
71. Terry told me that in 1994 during one 
of his many checkups, a cardiologist 
remarked that the operation could not 
have taken place, because open heart 
surgery had not been published in the 
surgical journals until 1959. 

God was with Terry those many years 
ago and I pray that He always will be. 

Douglas Stone '37, now retired, practiced 
surgery for more than 5t years in Baltimore. 
Maryland, and Asheville, North Carolina. This 
excerpt is reprinted with the permission of the 
Maryland Medical Journal (March/April 
1999; vol. 48, no. 2). 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



M BETTERS 



SECOND OPINIONS FROM OUR READERS 




Drug Deals 

The Summer 2001 issue of the Bullet in 
includes an erudite article by David 
Shaywitz and Dennis Ausiello on "the 
nature of medical breakthroughs" that 
features the statins. However, it is possi- 
ble to interpret the discovery and popu- 
larization of statins quite differently. 

Let us begin with their Lesson One: 
"Academia and industry are symbiotic." 
This is undoubtedly true. Big Pharma 
rules. And their bottom- line rule is "We 
support academics in order to find 
blockbuster drugs, then we promote 
those drugs relentlessly to develop an 
unassailable consensus position that can 
overwhelm/delay other effective but less 
profitable therapeutic alternatives." 

Perhaps that is why we had to wait for 
remote Australian researchers to uncov- 
er the gastroduodenal ulcer connection 
to Helicobacter pylori — a connection that 
Big Pharma (and any academics they 
could hold in thrall through research 
grants or peer pressure) missed and then 
ignored, thereby delaying definitive 
antibiotic therapy for most patients for 
many years. Eventually, it was not acade- 
mia but the Centers for Disease Control 
and Prevention that publicized this safe, 
definitive, and far less costly treatment. 

Similarly, the authors cite the most 
popular statin as a billion dollar drug, 
yet they admit that its apparent benefi 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



cial effect may hardly relate to cholesterol 
lowering at all. Of course, it takes hype to 
survive in a field of costly me -too drugs 
that may or may not act beneficially (all 
statins do have severe and even fatal side 
effects, as Bayer recently acknowledged). 
So at appropriate intervals, the medical- 
industrial complex has released 
announcements such as, "Statins may also 
be anti inflammatory!" (like aspirin?) and 
"They may delay dementia!" and "They 
may even combat bone disease!" Or 
maybe not. But for whatever reason, just 
keep prescribing those costly drugs until 
our patent runs out. 

My point? Inflammation is a sign, not 
a disease. In the stomach it was finally 
attributed to Helicobacter pylori after 
years of profitable delays. Similarly, it 
took a remote Finnish researcher to 
determine that Chlamydia pneumoniae 
DNA was present in the majority of dis 
eased coronary arteries that he exam- 
ined. And once again, the tremendous 
health-improvement potential of this 
repeatedly confirmed finding has large 
ly been ignored, except by a few acade 
mics running large well funded long 
term studies that won't report back for 
years (until the patent runs out?). 

In the meantime, we are urged not to 
try tetracycline or other equally safe 
and cheap (20 cents a day) antibiotic 
treatments for coronary artery disease 



because it might not help and "there is 
a high risk of bacterial resistance from 
antibiotic overuse." Apparently, some 
academics consider a few unautho 
rized, potentially life saving tetracy- 
cline applications far more likely to 
induce resistance than the thousands 
of tons of antibiotics routinely used in 
animal husbandry. 

On a personal note: I am a retired 
heart surgeon who underwent a six- 
vessel coronary bypass in 1983. Three 
years ago I developed angina at rest, 
which persisted unchanged, without 
treatment other than my usual atenolol 
and aspirin, for two weeks. After con 
sidering all options, I started myself on 
tetracycline (half a gram twice daily) 
and within eight days was once again 
chopping trees (slowly). I have since 
remained on that inexpensive anti- 
inflammatory antibiotic regimen with- 
out experiencing further coronary 
problems. I would ask any alumni who 
have had similar experiences, or who 
derived no value from antibiotic treat- 
ments for coronary ischemia, to share 
their information with your readers. 



ARNDT VON HIPPEL '57 
ANCHORAGE, ALASKA 



The Stress Factor 



I feel quite strongly that the role of cho 
lesterol in contributing to heart disease is 
overemphasized. I am not a cardiologist, 
but in my own case, in the case of family 
members, and in the course of treating 
many patients with heart attacks and 
coronary heart disease, I feel that stress is 
a far more important factor. 

I also believe that education does little 
to get rid of tobacco smoking, but raising 
the price of cigarettes does wonders. 

ROWLAND FRENCH '43B 
EASTPORT, MAINE 

Giving Unions Their Due 

I read with great interest "Stand & 
Deliver," the article by Joshua Sharfstein 
'96 and Yngvild Olsen '96 on the difficul 
ties faced by pregnant residents. I found 
it remarkable, however, that the article 



did not mention the most successful 
method to date in creating change in the 
work hours and leave policies in residen 
cy: resident unions. 

As a member and president of one of 
the largest and oldest resident unions, the 
University ol Michigan House Officers 
Association, I have seen firsthand the 
benefits of an organized voice for house 
staff. Our current contract proMdes for 
guaranteed paid maternity leave of six 
weeks (with the option to take an addi 
tional six weeks of unpaid leave) and no 
overnight call for the third trimester ol 
pregnancy and for two months postpar 
turn. Contrary to the presumptions made 
in the article, these special exceptions for 
pregnancy haw been widely accepted by 
house officers and faculty alike. 

In addition, for more than ten years, 
our house officers have been entitled to 
guaranteed days oft each month, long 
before the Accreditation Council on 
Graduate Medical Education even began 
to adopt policies on resident work hours 
(which to date still are largely unen 
forced). Our 28 year history of success at 
Michigan has shown that resident 
unions have been and will continue to be 
at the forefront in addressing the prob 
lems in the current system of residency 
training. As the direct voice of resident 
physicians themselves, resident unions 



remain committed to the betterment of 
residents' lives and, as a direct conse- 
quence, the improvement of patient care 
and resident education. 



VIKAS I. PAREKH '99 
\\\ ARBOR, MICHIGAN 



Hard Labor 



Sharfstein and Yngvild 



Drs. Joshua 

Olseris plea to make residency training 
more "humane" and to be treated more 
"fairly" will, 1 tear, tall on deaf ears unless 
they have some concrete suggestions as to 
how hospitals can meet three demands: 
patient coverage, costs of employment, 
and adequate training experience. With 
so much outpatient care, the last of these 
three is particularly ditticult, but the 
decrease in federal support tor medical 
education is also hard to overcome. 

More surprising, however, is their sug- 
gestion that being a doctor and having a 
normal life — which, I assume, means 
everything can be scheduled and the 
workweek is about 40 hours — are com- 
patible. I've never met anyone entering 
medicine who thought they would live 
like their nondoctor friends. The educa- 
tional process and the life requirements 
are all different and stressful, unless you 
love what you're doing. We all know that 
the incidence of divorce, alcoholism, drug; 




Stand & 1 Deliver 



sa—^ 



gHaBje 



usage, and suicide are greater in doctors 
than in comparably educated nondoctors. 
That is a reflection of the kind of people 
we pick to become doctors as well as the 
stress of the lifestyle. 

One question: Was Dr. Olsen thought 
ful enough when she went into labor to 
do so at 9:00 a.m. and complete it by 5 00 
p.m. so her obstetrician could get home to 
dinner and see his or her children? Would 
she have been just as happy to have her 
doctor say goodbye and let someone else 
do the job when he or she went off duty 
on schedule? Especially it there were 
problems or complications? Welcome to 
the profession, Drs. Sharfstein and Olsen. 
I'll await your solutions when you are 
heading up a residency program. Medi- 
cine is not easy unless you love it. 

ALAN R. SPIEVACK "59 
CAMBRIDGE, MASSACHUSETTS 

The authors respond: We did not write — 
and do not believe — that medicine is a 
nine to five job. However, we also dis- 
agree with the idea that medicine must 
be a nine to five the following-day job. 
We support the hours restrictions 
recently put forward by the American 
Association of Medical Colleges, which 
would limit resident shifts to 24 hours 
and cap the workweek at 80 hours. 
these reasonable guidelines now need 
to be adopted and enforced by accredit 
ing organizations. 

JOSHUA SHARFSTEIN '96 
YNGVILD OLSEN '96 
BALTIMORE, MARYLAND 



A Midsummer Nice Read 

I just wanted to congratulate you on the 
excellent Summer 2001 issue of the Bui 
letin. The cover alone was so stirring, and 
the pieces were fascinating. 

ED COBURN 

BOSTON, MASSACHUSETTS 

The Bulletin welcomes letters to the alitor. Please 
send letters by mail (Harvard Medical Alumni 
Bulletin, 25 Shattuck Street. Boston. Massachu 
setts 02115); fax (617 584 8901); or ennui (hul 
ktin@hms. hatyard.edu). Letters may be edited for 
length or clarity. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



P U LAE 



MAKING THE ROUNDS AT HMS 



Gottlieb 




Hospital Leadership 

New hospital presidents were 
recently announced at Brigham 
and Women's Hospital and Beth 
Israel Deaconess Medical Center. 

Brigham and Women's named 
Gary Gottlieb, HMS professor of 
psychiatry and chairman of the 
Partners Psychiatry and Mental 
Health System, to serve as the 
hospital president. He will replace 
Jeffrey Often, who announced in 
November his intention to step 
down after nine years at the 
hospital. From 2000 to 2001, 
Gottlieb served as president of 
North Shore Medical Center; 
before coming to Massachusetts, 
he was director and chief execu- 
tive officer of Friends Hospital in 
Philadelphia. 

Paul Levy, HMS executive dean 
for administration, was unanimously 
selected by the Board of Trustees at 
Beth Israel Deaconess Medical 
Center as its new president and 
chief executive officer. In his posi- 
tion at HMS, he was responsible for 
administrative, budgetary, and facil- 
ity management as well as govern- 
ment and community relations. He 
was also involved in coordinating 
collaborative ventures between 
HMS and its affiliates. ■ 




High-Tech Teaching 



HE HMS CENTER FOR EDUCA- 

tional Technology has 
opened its doors to faculty 
seeking ways to 

incorporate new technolo 

gies into their teaching. The 

first of its kind in the coun 

try, the center offers a full 

range of digital services 

and equipment, educational 

technology expertise, and 

technical support staff. It 

also administers a grant 

program for new curriculum initiatives. 
"We at HMS are now well positioned 

to take a national leadership role in the 



TECHNOLOGIES 
FOR TEACHING 

Video Streaming 

Radiographic 
Scanning 

Digital 
Microscopy 



use of information technology to fur- 
ther medical education," says John 
Halamka, associate dean for education- 
al technology. "When you 
combine the ubiquity of the 
Web with the rise of wire- 
less and portable technolo- 
gy, you have the capacity to 
make all of our education- 
al resources available any- 
where, anytime." 

Major features of the 
center include digital 
imaging services, such as video stream- 
ing, radiographic scanning, and digital 
microscopy. ■ 



IT'S ALL IN THE GENES 




INGENUITY AT 
WORK: Raju 
Kucherlapati, 
the Paul C. 
Cabot Professor 
of Genetics at 
HMS, is scientific 
director of the 
Harvard-Partners 
Center for 
Genetics and 
Genomics. 



The Harvard- Partners Center for Genetics and Genomics has 
opened a new genotyping facility. This core laboratory provides 
flexible, high-quality, high throughput SNP genotyping to HMS, 
the Harvard School of Public Health, and hospitals in the Partners 
HealthCare network. Raju Kucherlapati, the Paul C. Cabot Profes- 
sor of Genetics at HMS, is scientific director of the center. ■ 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



BUILDING BRIDGES: 
Joan Reede's Office for 
Diversity and Community 
Partnership will guide 
diversity efforts at Har- 
vard Medical School. _ 





Leading the Charge 



OAN REEDE, FORMER ASSOCIATE 

dean for faculty development 
and diversity, has been named 
the first dean for diversity and 
community partnership at HMS. Under 
her leadership, the new Office for Diver 
sity and Community Partnership will 
promote increased recruitment, reten 
tion, and advancement of underrepre 
sented minority faculty at HMS; oversee 
all diversity activities involving HMS fac- 
ulty, trainees, students, and staff; and 
coordinate the School's many interac 
Lions with community groups. 

In appointing Reede, HMS Dean 
Joseph Martin noted that "Joan possesses 
strong leadership, networking, and con 
sensus-building skills. Her success in 
developing new and exciting programs to 
enhance diversity efforts throughout the 
HMS community has been outstanding." 
In the 2000 2001 academic year, HMS 
programs designed to foster an interest 
in science among minority students 



served 452 participants, ranging from 
kindergartners to high school students. 
The Visiting Clerkship Program, which 
aims to increase minority medical stu- 
dents' awareness of opportunities in aca- 
demic medicine, had nearly 500 partici- 
pants. Research funding awards have 
been made to minority faculty members 
through the Bridge Award Program. And 
the Commonwealth Fund/Harvard Uni- 
versity Fellowship in Minority Health 
Policy has graduated 23 fellows since it 
began in 1996. 

"In seeking excellence in education, 
research, and clinical care," Reede says, 
"there is a clear need to recognize and 
incorporate the talents, skills, and knowl- 
edge of diverse individuals and to under 
stand that Harvard Medical School, as 
part of a larger community, must work 
collaboratively to address issues of health 
disparity, cultural competence, work 
force diversity and, ultimately, quality 
health care." ■ 




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WINTER 2002 • HARVARD MEDICAt A1UMNI BULLETIN 




TDENT'S REPORT 




I |s\o| CLEAR who reads the 
President's Report — other 
than the president — in each 
issue of the Bulletin. Even the 
president will sometimes read the col- 
umn and say, "I don't remember writing 
any of this." Sometimes past presidents 
read the current president's message 
and say, "I wonder who wrote that." Or 
presidents -elect read the message and 
say, "Well, I'm not going to write any- 
thing like that." This is in contrast with 
the articles of the Bulletin, which are 
widely read and about which we often 
say, "I wish I had written something 
like that." 



described the methodology in the paper, 
or in the appendix — I forget which. 

This report is, in fact, about email and 
the Alumni Association. About 55 per 
cent of HMS alumni are now networked 
to the Alumni Association office. 
Through the remarkable efforts of Nora 
Nercessian, the assistant dean for alum 
ni affairs and special projects; John 
Halamka, the HMS associate dean for 
educational technology; and immediate 
past President Charlie Hatem '66 — and 
with the support of Dan Federman and 
Dean Joe Martin — the Alumni Associa 
tion is now able and ready to survey 
both the body politic and target popula- 



Twice this calendar year, you will receive 
brief email surveys on topics important 
to the School, particularly education. 



I recently wrote a medical journal 
article entitled "The Summer Solstice 
Has Been Rescheduled to August 21." 1 
am mentioning this article just to test 
whether you are actually reading this 
message. If we get email from you at the 
Alumni Association office about the 
generally bad timing of the solstice each 
summer, I will tell the two presidents- 
elect, the past president, and Dan Feder- 
man '53 that these presidential messages 
arc being read. 

Some of you probably think that the 
solstice is not a big medical issue. Well, 
il we didn't have the summer solstice, 
the days would just get longer and 
longer — or, in the Southern Hemi- 
sphere, shorter and shorter — and scien- 
tists at a major midwestern university 
might think that the pituitary-adrenal 
axis would be doomed. Hence, my con 
cern. So we need the solstice, but 
rescheduling it for late August from 
June 21 gives us a lot more daylight dur- 
ing summer vacation, and many scien- 
tists see this as a plus. Just how to do 
this is not a big deal and I have 



tions of alumni. The system was test- 
marketed last year and it works. I 
recently contacted five other medical 
schools and found that none of their 
alumni offices had the capability of 
reaching alumni electronically. 

Twice this calendar year, you will 
receive brief email surveys on topics 
important to the School, particularly 
its educational missions. Through this 
email mechanism you will be able to 
help shape the agenda and delibera 
tions of the Alumni Council and to pre 
sent your views to Dean Martin. In the 
next year, the Council will also seek 
from you the measures you personally 
use to place value on what you do pro- 
fessionally in this era of health care sys- 
tem tumult. We will also use the Web 
to provide updates on plans for alumni 
activities, particularly those that take 
place at the time of medical school 
graduation. We look forward to hear 
ing from you regularly. ■ 

Paul J. Davis '63 is senior associate dean for 
clinical research at Albany Medical College. 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 




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BOOKS BY OUR ALUMNI 



BOOKSHELF 




Idaho Mountain Wildflowers 

A Photographic Compendium, by A. Scott 
Earle '53 (Larkspur Books, 2001) 

A lifelong love of nature, mountains, 
and photography is reflected in Earle's 
collection of more than 300 color 
images of mountain wildflowers. The 
flowers illustrated are typical of flora 
found in Central Idaho; all grow at alti 
tudes ol 6,000 feet or higher. 

In Darwin's Image 

How Human Biology c onfirms Evolution 
Theory, by Arndt von Hippel '57 
(lstBoohs,2001) 

Lite's origin provides the point of depar 
ture for this book, which reviews the 
layered progression from bacterium to 
nucleated cell to multicellular organism 
and examines the efficiencies gained 
through cell specialization. The author's 
overview of human biology concludes 
with evolutionary insights into human 
sexuality and embryonic development. 

Out of Its Mind 

Psychiatry in Crisis — A Call for Reform, 
by J. Allan Hobson '59 and Jonathan A. 
Leonard (Perseus Publishing, 2001) 



This book considers what's wrong with 
the field of psychiatry today, how it got 
that way, and how to fix it. Hobson and 
Leonard demonstrate that psychiatry 
now suiters from a lack of public confi 
dence and a "split-personality" disorder 
in which humanistic therapy is often 



poorly coordinated with, or even 
divorced from, biomedicine. They pro 
pose the development of a balanced 
approach to treatment — ncurodynam 
ics — that bridges the worlds oi biomed 
icine, therapy, and neuroscience. 

Borderline Personality Disorder 

A Clinical Guide, by John G. Gunderson 
'67 (. \menean Psychiatric Publishing, 2001) 

The author, whose research helped 
establish borderline personality disor 
der as a psychiatric condition, evaluates 
the strengths and weaknesses of various 
diagnostic and treatment perspectives 
He addresses his own approach, psy- 
chodynamic therapy, as well as "dialec 
tical" behavioral therapy, group and 
family therapy, and pharmacotherapy. 
Gunderson also offers insights and case 
examples from his clinical experience, 
and takes the reader through the phases 
of the typical course of treatment. 

Matters of Life and Death 

Making Moral Theory Work in Medical Ethics 
and the Law, by David Orentlicher '81 
(Princeton University Press, 2001) 

The author draws upon his experience 
in both medicine and law to address 
the translation of moral principle into 
practice, using controversial life-and- 
death issues as case studies. He evalu- 
ates three models, including physician- 
assisted suicide; the debate over forcing 
pregnant women to accept treatments 
to save their fetuses; and the denial of 



life-sustaining treatment on grounds of 
medical futility. Orentlicher argues 
that important debates in bioethics can 
be better understood when one takes 
into account moral concerns that arc- 
often overlooked. 

Landscape with Human Figure 

by Rafael Campo '92 
(Duke University Press, 2002) 

Campo's fourth collection includes 
poems that address a range of human 
experiences, including the doctor/ 
patient relationship, the ravages of 
AIDS, healing and suffering, identity, 
sexuality, and love. A teacher and prac- 
titioner of general internal medicine as 
well as an award winning poet, Campo 
vividly demonstrates the healing power 
ol words. 

This Side of Doctoring 

Reflections from Women in Medicine, 
Eliza Lo Chin '93, editor 
(Sage Publications, 2001) 



This collection of stories, poems, and 
essays, written by female physicians over 
the past 150 years, offers a fresh perspec- 
tive on doctoring. Organized into cate- 
gories such as "Life in the Trenches: 
Internship and Residency," "Mothering 
and Doctoring," and "Making Choices," 
the anthology explores the struggles and 
triumphs of women in medicine. Chin 
also provides a historical overview of the 
obstacles faced by nineteenth- century 
women physicians. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 




BENCHMARKS 



DISCOVERY AT HMS 



Spoiling for a Fight: Fruit Fly Model Helps Research on Aggression 




HE FIGHT BEGAN AS THESE 

fights often do. The two male 
rookies circled each other 
warily. Making the first move, 
the yellow clad youth approached and 
charged his competitor. The one wearing 
the white spot bristled in defense, seized 
the offensive, and lunged in retaliation. 
Wings flared. White soon chased off yel- 
low, ending the fight and establishing 
dominance in mere seconds. 

Without the catchy superlatives or 
clever nicknames usually associated 
with the sport of boxing, this fight club 
for fruit flies has been going on for 
more than a year in the laboratory of 
Edward Kravitz, the George Packer 
Berry Professor of Neurobiology at 



HMS. The mild mannered Kravitz has 
promoted more fights than Don King. 
For 20 years, pair after pair of young 
lobsters have challenged, darted, and 
wrestled their way to dominance or 
defeat. Then last spring, Kravitz's 
research team began staging matches 
involving the common laboratory fruit 
fly, Drosophila melanogastcr. 

The researchers are collecting base- 
line data to calculate statistically what 
constitutes a "normal" fight. Based on 
preliminary analysis, the fights and sub- 
sequent behaviors seem to follow rules 
set by a combination of genetics and 
fight outcomes. Kravitz wants to use 
the fighting fruit fly model system to 
explore the neurobiology of aggression. 




PUT UP YOUR DUKES: The research team of Professor Ed Kravitz and undergraduates 
Selby Chen, Ann Lee, and Nina Bowens (not pictured) has scored dozens of fights 
between fruit flies, hoping to gain more insight into genes underlying aggression. 



In this case, normal does not mean 
natural chance encounters. The fights 
take place between pairs of three-day-old 
males, raised in isolation and then 
trapped together in a small, temperature- 
controlled, clear plastic and glass cham- 
ber. There a headless, pregnant fruit fly 
perches on a bottle cap- sized food cup. 
(Females with heads intact tend to fly 
away from the fight.) The female lures 
the males to the cup, where the flies 
instinctively wage a turf battle. On one 
side of the chamber is the close-up lens of 
a digital camera set on a tripod. 

So far, the researchers have videotaped 
75 fights between flies involving 2,000 
rounds. Fights can be decided after 
encounters as short as a few seconds or 
as long as 1.5 minutes. The average time is 
11 seconds. The first male to reach the 
food surface usually picks the fight. 

The researchers score rounds at three 
intensity levels. High level encounters 
last longer (26 seconds) than mid- and 
low-level rounds (12 and 6 seconds, 
respectively). After a high intensity 
round knocks the loser off the fruit cup, 
the defeated fly takes about twice as long 
to engage in another encounter (52 sec 
onds) as it takes after a low intensity 
encounter (28 seconds). The difference 
suggests a long-term component to the 
fighting behavior. 

This long-term component may 
reflect changes in gene expression in the 
brain. Two decades of researching the 
conveniently large neurons in the lob- 
ster has helped Kravitz define some of 
the neurotransmitters important in 
aggressive behavior, and to identify cir 
cuitry important in the winner and 
loser roles adopted by the lobsters. 

"We don't know how, but the busi 
ness of being beaten clearly has a dra- 
matic effect on the life of a lobster," 
Kravitz says. "After a fight, one becomes 
dominant, the other subordinate. The 
dominant animal advances all the time, 
and the subordinate runs away and 
won't fight. After a half hour of fighting 



12 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



in lobsters, animals can remember for 
up to a week who is a winner and who is 
a loser without having any fights in 
between and after being separated from 
each other." 

Fruit flies offer Kravitz and his col 
leagues an opportunity to use new- 
genetic research tools to explore 
changes in gene expression related to 
changes in social experience and to 
identify pathways important in animals' 
aggressive behavior. 

"Aggression is a serious problem in 
society, but even after studies of lots ol 
animal models tor many years, we don't 
know a lot about the biological basis of 
aggression," Kravitz says. "We know that 
some chemicals like serotonin are very 
important, but beyond that, much 
remains to be discovered." 

If nothing else, it is a Held of study that 
will never be dull. ■ 



FLIES OFF THE HANDLE 




Rarely seen, fruit-fly fights can reach 
a high level of aggression when the 
animals box (left), wrestle, and tussle. 
Mid-level aggressive moves are more 
common (below left), such as the 
close chase by the winning fly on the 
right and the defensive wing threat 
by the loser on the left. Most fights 
are decided by low-level aggressive 
moves, such as a wings-up display 
(below right), charging, or a limb 
lifted to the side. 



Carol Cruzan Morton is a science writer 

for Focus. 




ON THE SCENT 




he brain takes only a split second to perceive and 
respond to a smell, whether it be the aroma of 
roasting turkey or the sour odor of leftovers gone 
bad. But it has taken a long time for researchers 
to meticulously trace sensory information from the nose to the 
brain, which ultimately perceives thousands of different odors. 
Now, researchers have shown how information from nasal 
odor receptors is organized in the brain's olfactory cortex. 

The olfactory cortex has a sensory map that is virtually identical 
in different individuals, report Howard Hughes investigator Linda 
Buck, an HMS professor of neurobiology; postdoctoral fellow Zhi- 
hua Zou; and their colleagues in the November 8 issue of Nature. 
The nose has about a thousand different types of odor receptor. In 
the study, information from each of two types of receptor reached 
distinct clusters of neurons in all five olfactory cortical regions 
except for the amygdala. The patterns were consistent among ten 
knock-in mice for each of the two individual receptors studied. 

"This was in the mouse, but humans use the same strategies 
to detect and discriminate odors," Buck says. "The invariant 



arrangement may explain in part why people have similar sen- 
sations of particular odor chemicals. Most people agree that 
skunks do not smell good, but roses do." 

Finding odor patterns in the brain may be enough of a sur- 
prise for some people, but the results also suggest a reorgani- 
zation and possible integration of information from different 
odor receptors for further distribution to higher processing lev- 
els, where they may trigger different odor perceptions as well 
as instinctive and emotional responses. And inputs from the 
same receptors may be processed at the same time by func- 
tionally distinct areas of the olfactory cortex before the infor- 
mation is forwarded in the brain. 

"We still don't know exactly how different chemical struc- 
tures are ultimately translated into perceived odors," Buck 
says, "but we do know now that sensory information under- 
goes a dramatic transformation in the olfactory cortex, and 
that there is a highly organized pattern of sensory inputs — 
order that some people thought did not exist." 

— Carol Cruzan Morton 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 




BENCHMARKS 



DISCOVERY AT HMS 



in Good Time: Setting the Orcadian Clock 




RECENT STUDY REVEALS ONE OF 

the first glimpses ol how the 
brain's circadian clock — a 
tiny cluster of neurons behind 
the eyes — sends out signals that control 
the body's daily rhythms. The newly dis 
covered pathway opens a long closed 
door in the field of circadian clock 
research and could ultimately lead to 
novel treatments for sleep disorders and 
other circadian disturbances. 

"If you could figure out the factors 
that promote wakefulness and sleep, that 
could in principle be turned into better 
drugs for particular sleep disorders," says 
Charles Weitz, HMS professor of neuro- 
biology. His team's findings appear in the 
December 21 issue of Science. 

Circadian researchers have been 
remarkably successful in the past few years 
at identifying the molecular machinery 
that makes the clock cells of the suprachi 
asmatic nucleus (SCN) tick on a nearly 24- 
hour basis. But they were stymied when it 
came to figuring out how that machinery 
actually drives daily rhythms such as the 
rise and fall of body temperature and the 
sleep-wake cycle. They suspected that the 
rhythmic patterns were achieved by a 
turning on and off of beha\iors and that 
this switching was produced by factors for 
activation and inhibition. They even had an 
idea where the factors might reside in the 
brain, but no one had yet found any. 

Stopping the Clock 

Weitz, Achim Kramer, and colleagues have 
identified the first of what could be several 
inhibitory factors controlling the circadian 
rhythm of locomotion in a mammal, in this 
case, the hamster. (Circadian locomotor 
patterns, which are characterized by peri 
ods of spontaneous movement occurring 
at the same time each day, exist in humans 
but are highly influenced by external fac 
tors.) In addition, they have found that the 
factor, TGF-alpha, works through a mid 
dleman, the EGF receptor. Both proteins 



appear to be highly expressed in exacdy 
the spots that had been predicted — TGF- 
alpha in the SCN and the EGF receptor in 
the nearby hypothalamus. 

Yet there are several unexpected aspects 
ol the discovery. To begin, it appears that 
the molecular duo regulates not just daily 
physical activity patterns but also the 
alternating pattern of wakefulness and 
sleep. More surprising, perhaps, is the dis 
covery that the EGF receptor middleman 
appears to receive information in the form 
of TGF-alpha not just from the clock but 
also from the eyes. This is exciting because 
circadian rhythms, though controlled by 
the clock, could be influenced by the out- 
side world and, specifically, by light trans- 
mitted through the retina. 

"In the real world, it is both effects — the 
clock effect and some light effect — that are 
really sculpting behavior," Weitz says. "No 
one had explicitly raised the possibility 



that the signal from the retina and the SCX 
might involve the same ligand or at least a 
ligand for the same receptor." 

In the Eye of the Beholder 

To find the missing factors, Weitz, Kramer 
(who was then an HMS research fellow in 
neurobiology), and their colleagues intro- 
duced SCN-produced proteins into the 
brains of hamsters for a period of three 
weeks to see which might inhibit the nor- 
mal locomotor activity pattern. Normally, 
the nocturnal hamsters are very pre- 
dictable — jumping on a running wheel at 
almost exactly the same time each evening 
and for the same duration. The hamsters 
receiving TGF-alpha, however, refrained 
from this habit for the three week experi 
mental period. At the end of this time, 
they jumped right back on the wheel. But 
it was still not certain whether their laxi- 




14 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



ty during the experiment had been due to 
some disruption in their circadian rhythm 
or to a more basic motor impairment. 

Once the researchers confirmed that 
TGF alpha was working through the EGF 
receptor and that the pair was located in 
the expected regions, they conducted a 
series oi physiological tests on the TGF- 
alpha animals to answer this question. The 
tests showed that the animals moved just 
fine around their cages, though not on the 
wheel, suggesting their motor systems 
were intact. Yet their sleep patterns were 
strange. "It appeared the high concent ra 
tion of TGF alpha was blocking some cir 
cadian input and removing them from the 
sleep wake cycle," Weitz says. 

Since the animals had been experi 
mentally manipulated, Weitz and his col 
leagues still wanted to know if TGF 
alpha and the EGF receptor were regulat 
ing circadian patterns in the real world. 
Fortuitously, nature had produced a con 
vcnicnt experiment: a strain o\ mice with 
a defective version of the EGF receptor. 
"No one had ever looked at their locomo 
tor patterns." Weitz says. It turned out 
that the mice — deprived ot the hill 
inhibitory activity of the receptor — were 
much more active than normal mice. 

Intriguingly, the disparity with normal 
mice was more marked in animals living 
under a normal light dark regimen than 
those lhing in total darkness. Normal 
mice, when exposed to light, stop mov 
ing, perhaps as an adaptive response, 
which can result in less activity. The 
researchers found that this effect was 
impaired in the EGF receptor-deficient 
mice raised under light dark conditions, 
which exaggerated their difference with 
normal mice raised similarly. 

Thinking that the EGF receptor might 
be receiving signals from the retina as 
well as the clock, the researchers looked 
for TGF alpha in the retina. They found 
it, along with another receptor stimulat 
ing protein, EGF. "So it all fits together," 
Weitz says. ■ 




GREAT MINDS THINK ALIKE 



Pain and Pleasure Activate the Same Brain Structures 



he notion of a fine line between pain and pleasure is 
finding support in biology, according to a new report 
by Massachusetts General Hospital researchers. 
David Borsook and his colleagues have discovered 
that circuits in the brain that are responsible for reacting to plea- 
surable experiences also respond to painful ones. 

Even more surprising, some of the circuits associated with reward 
appear to react more quickly to hurtful stimuli than do the sensory 
areas of the brain traditionally associated with pain. The findings 
appear in the December 6 issue of Neuron. 

The idea for the study arose in part out of Borsook's experience 
as a clinician. "Over 15 years of seeing patients with pain it 
became obvious that we do not have good methods of assessing 
chronic pain," says Borsook, HMS associate professor of radiolo- 
gy. "And we do not have good methods for treating it." 

To get a better understanding of the actual neuronal circuits 
involved in pain, Borsook — along with Lino Becerra, HMS assistant 
professor of radiology, and their colleagues — attached thermodes, 




GOOD GRIEF: The same areas of the brain (highlighted above) 
respond to both painful and pleasurable stimuli. 



which deliver either warm or painfully hot temperatures for 25 
seconds, to the hands of eight male volunteers. They imaged the 
brains of each subject as he was exposed to the stimuli. 

The painful hot temperatures activated not only the classic pain 
circuitry but also structures previously identified as being activated 
in response to emotionally rewarding stimuli, such as cocaine, 
food, and money. The emotional circuits became most active imme- 
diately after heat exposure, while the sensory areas showed their 
greatest burst of activity later in the 25-second interval. 

"It's the first time we have seen something aversive activating 
these reward structures," Becerra says. One explanation is that 
these areas are simply responding to salient stimuli. 

Gaining a better grasp on the pain circuitry in the brain could 
lead to new treatments. "Prior to our study, most data could define 
the sensory response," Becerra says. "Understanding this newly 
identified emotional component may be a key to developing new 
approaches to helping chronic pain patients, who are at increased 
risk for anxiety, depression, and suicide." 

— Misia Landau 



Misia Landau is senior sciencewriter for Focus. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



What happens when physicians don't care for the patients they're cari 



by RAFAEL CAMPO ■ When I arrive, she is sitting 
beside her hospital bed, in one of those tall, vinyVuphoV 
stered chairs that looks like it might recline comfortably, 
but actually doesn't. An adjustable tray bearing what 
might be called lunch is angled before her, as though she 
has pushed it away, I can see through the translucent 
plastic covers on the plates that she hasn't touched any of 
it, not the perfect scoop of mashed potatoes, not the gray- 
brown square of pot roast, not the pyramid of tiny wrin- 
kled peas. Futuristically geometric food, suitable to 
the sterile confines of the wards, surroundings as white 



16 HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 







I 



mf< 







k 



I 








I should say something 
me. I had never noticed 



and airless as what we imagine a spaceship's 
interior would be like. Faint humming from 
nowhere and everywhere, and sporadic beeps. 

"Oh, it's you," she says, and I return from the 
future. She is wrapped in the standard -issue, 
blue-checkered hospital gown. She looks terribly 
gaunt. I remember why I've come. 

I am trying to understand why I have never 
liked Miss Twomey.* I have been her doctor for 
more than six years. During that time, surely, the 
cancers, one in her colon and another in her 
breast, slowly developed and grew, and maybe 
even metastasized. I suppose I should admit that 
when she came to see me last week, dressed in her 
usual prim attire — the same beige cable knit 
sweater loosely buttoned over the same cream 
rayon blouse, and the same calf-length navy blue 
pleated skirt — I had felt something akin to \indi 
cation as she complained, matter-of-factly, that 
she was feeling listless. Her cheap perfume, as on 
previous visits, only partially obscured the sour 
odor of old sweat from beneath her arms. 

I knew as soon as she had walked in my office 
that day that she was out of sorts. Though her 
clothes were neat as ever, I noticed that her 
white hair was not as carefully groomed as it 
usually was. Her thin lips were a faint purple 
color, and she swooned slightly, steadying her- 
self on my arm when she rose for me to check her 
blood pressure. I don't think she had ever spon- 
taneously touched me before. When I felt 
through the sleeve of my shirt how cold her hand 
was on the back of my arm, I was sure she must 
be anemic. At her advanced age — she would be 
84 in December, just a few weeks away — I 
guessed even then that it would turn out to be a 
cancer of some sort. What surprised me was the 
feeling I had that she deserved it. 

Just as she had that day in my office, she sits 
with her hands folded in her lap, looking impas- 
sively ahead so that I am kept in the periphery of 
her field of vision. "They tell me it's bad," she says. 
A long pause, before she adds, "The cancer." By 
"they," she is referring to the hospitalist, I think, 
and the general surgeon, who have been manag 
ing her care since she was admitted, the day after 
our last visit. She had turned out to be anemic — 
hematocrit of 20, to be precise, with a marked 
microcytosis. The colonoscopy I arranged urgent 



ly, with the help of the clinic social worker, who 
assisted her with the last minute transportation, 
showed a six-centimeter adenocarcinoma in the 
ascending colon. I can't imagine the indignity of 
the test for her, she who was too proper to allow 
me to examine anything more than her blood 
pressure on her biannual visits; even harder to 
imagine is the medical student examining her 
breasts upon her admission to the hospital, and 
finding the mass the size of a baseball. "I should 
have let you do the mammogram," she says now, 
resigned if anything, and not particularly regret- 
ful. Her hand clutches absently at the opening of 
her gowm below her neck. 

I suppose I should say something comforting, 
but the spiky whiskers on her chin stop me. I had 




18 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



*Namc has been changed to protect confidentiality 



comforting, but the spiky whiskers on her chin stop 
them before; they glisten a little in the sunlight. 



never noticed them before; they glisten a little in 
the sunlight the window lets in. Though I've been 
in these hospital rooms hundreds of times before, 
today the windows seem so large, as if to encour- 
age breathing, or even flight. Miss Twomey's 
overlooks the women's college's athletic fields 
across Brookline Avenue, vast green squares, 
almost pastoral. I notice their manicured appear- 
ance reflected in her wide rimmed glasses, their 
milky white plastic frames, inexpensive and 
unfashionable, like the last pair my grandmother 
wore. Life and order juxtaposed on dissolution 
and death, I think rather heartlessly; not even the 
unusual warmth of the late autumn day outside, 
or the fleeting memory of my own grandmother, 
inspire my pity 



is enough to 




It isn't that Miss Twomey routinely refused 
almost all of the health maintenance intcrven 
tions I would offer her; it isn't her South Boston 
Irish accent, either, that I find so distasteful, or 
even her body odor. And yet I can't put my finger 
on it. I am not used to problems with empathy. 
Besides my work as a physician, I am also a poet, 
and when I give readings of my work, I like to talk 
about empathy. I like to share one story in partic- 
ular about when I was a young resident, and one 
of my attendings wrote an evaluation that criti- 
cized me for identifying too strongly with my 
patients. Usually, the audience gasps and groans 
a little when they hear this story; sometimes, 
tears come again to my eyes when I tell it, because 
after all these years the cruelty of those words, 
scrawled hastily on a sheet of yellow lined paper 
stuffed in a folder with my name on it, still stings. 

I am no longer a thin skinned trainee, though, 
and 1 have no attending telling me to be tougher, 
so why can't I empathize with Miss Twomey? 
Why can't I reach out, and take her hand in mine? 
Suddenly, my mind is flooded with all the obsta- 
cles to empathy that I am so fond of reciting, famil 
iarly framed problems for the medical students 
and residents: the burgeoning technologies oi 
medical science, which place ever more machines 
between doctors and patients; the constraints of 
managed care, which puts the interests of the 
afflicted at odds with those of their caregivers in 
complex ways; the challenges of an increasingly 
multicultural society, through which each comes 
to see the other as incomprehensibly alien. 

True, Miss Twomey had been diagnosed with 
the help of expensive machines, but none inter- 
posed themselves at the moment; even the 
device that controlled her IV fluid rate was 
turned off, its fat gelatinous bag of saline sus- 
pended unconnected to anything, as if sulking in 
the corner of the room. True, she had a type of 
insurance that failed to reimburse fully the hos- 
pital's charges for the care she required, but no 
utilization review nurse was knocking to tell us 
she must be discharged today. Even the fact of 
our disparate points of origin seemed irrelevant; 
if anything, as children of immigrant parents, 
albeit from different generations and different 
island cultures, we likely had more in common 
than most doctors and their patients. Standing 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



WUH C IT'C 



probably true thai 
I've always believec 



here in her doorway, feeling intensely how much 
1 don't want to sit on her bed and stay to chat, 
this litany sounds canned, glib. 

One common response to my lectures, usually 
posed by a silver haired Marcus-Welby gone- 
wrong type in the back of the auditorium, is that 
one can't teach empathy; it's either there some- 
where inside a person, he says gruffly, or it's not. 
I love this objection, because I get to retort that 
while it's probably true that empathy can't be 
grafted onto the unwilling soul, I've always 
believed that at the very least it can be modeled, 
and through such modeling, even the most rudi- 
mentary or stunted capacity for empathy can be 
nurtured. Bring poems about illness on rounds, I 
say; embrace a patient after the physical exami- 
nation is concluded; remain open to sharing a 
spontaneous joke. Make a point of asking for any 
questions, or greeting family members who 
might be present at the bedside. 

If his beeper hasn't gone off calling him away 
to a less philosophical situation — I know he 
must have a very sick crew of inpatients, and I 
empathize with him, imagining his frustration 
in treating the GI bleeder with alcohol with- 
drawal seizures in the ICU, or the demented 
elder who isn't safe to return home alone but 
who is repeatedly declined placement in long- 
term care facilities, or any of countless other 
commonplace and irremediable scenarios — my 
interlocutor usually looks exasperated by my 
answer, as if one more unreasonable demand has 
just been made of him. 

I know I am often dismissed as a daydreamer, 
an impractical poet, so I often try to buttress my 
arguments with references to the likes of the lit- 
erary theorist Susan Sontag or the social anthro- 
pologist David Morris; sometimes, I cite political 
activist authors like Adrienne Rich or the late 
Audre Lorde. I give examples of how negative 
metaphors for illness constructed by our culture 
can color our thinking about our patients, when 
we talk of blasting tumors with radiation or 
when we imagine the agony of withdrawal as a 
kind of punishment to the narcotics addict; I 
point out how the kind of language patients 
might use to describe their own experiences of 
illness, more positive and affirming, might fuel a 
mind-body interaction within them that has 



healing potential. By now, the room is 
beginning to empty of audience, and 
the drug rep starts to pack up any left 
over sandwiches; they are all returning 
to the innumerable stories they are 
helping to construct, barely awakened 
to their role in those dramas, happier 
to ignore the messy cultural fascina- 
tions and distortions that — so much 
more than x-ray interpretations or 
biopsy results — define the experience 
of illness, intent only that the onerous 
work of the hospital continue. 

Miss Twomey gazes toward the 
windows; I realize that my rumina- 
tions have been prolonging our 
uncomfortable silence. Then she says 
it, as though she were addressing one 
of the large oaks that blaze orange at 
the far end of the fields. "I'm not afraid 
to die, like you think I am." Her words 
are punctuated by the distant shouts 
and laughs of the Simmons field hock- 
ey team, which has begun to spill like 
some of life's happy disorder onto the 
perfect grass; afternoon practice, the 
thrill and release of being free of the 
classroom and the library, free of con- 
cepts and chalkdust and theories, in 
the realm of the body, the physical, the 
pleasure of adrenaline and hard 
breathing. By the time the young 
women begin their scrimmage, Miss 
Twomey is quietly sobbing. 

Several weeks later, I find myself 
writing again, and I am writing about 
Miss Twomey. Her tears seem more 
than a vivid detail that describes my 
visit with her that day; now, I understand them 
as a form of language itself, perhaps the only lan- 
guage that can accommodate a definition of 
empathy. The poem I write, and now this essay, 
can only approximate the feeling that joined us 
at that moment; indeed, one of the pitfalls of 
empathy is the kind of paradoxical hubris it can 
breed, tempting us to believe that we can truly 
know and thus explicate the experience of 
another person's suffering. Yet such is our utterly 
and fundamentally human limitation, each of us 



20 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



empathy can't be grafted onto the unwilling soul, 
that at the very least it can be modeled. 




born into families and communities full of their 
mysteries and contradictions, their pleasures and 
their pain, human gatherings that we yearn to 
join; equally human, it seems, is our impulse to 
transcend that limitation, to attempt to make 
sense of that innate need for communion. 

For whatever reason I could not embrace Mary 
Twomey that awful day — shame or guilt, revul 
sion or rage — to tell the story of us, together amid 
those tears, the day declining into a night as sore- 
ly purple-red and inflamed as a bruise, an injury I 



know I will someday face myself, is a biological 
drive, a process of living. Here, then, is the reason 
I am hopeful; here, in this brief narrative I create, 
this tether between two people, is the meaning 
we all seek in Me. ■ 

Rafael Campo '92 practices medicine at Beth Israel 
Deaconess Medical Center He is the author of a collection 
of essays, The Desire to Heal, and four books of poetry: 
The Other Man Was Me; What the Body Told; 
Diva; and Landscape with Human Figure. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



21 




ill 



MIST! 



HHI^^HH 




A gentlemanly mentor once said: In the beginning, you 
must find something to admire in a patient. 
The relationship does not always end in admiration, 
he explained. But it must begin that way. This is 
our oath of good care and intention, taken fervently, 
but not always possible. ^ The patient had arrived 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 23 



IN A VOICE 



between a sandblaster 
list the details of the 



months ago with 18 years of diagnoses: impulse 
control disorder, attention deficit disorder, 
obsessive compulsive disorder, narcissistic dis 
order, and — from one annoyed diagnostician — 
inadequate personality. He had a knitting bas- 
ket of diagnoses, which helped to understand 
him — you could plunge your hand in anywhere 
and pull out a color — but not a single 
admirable quality that helped to excuse him. 

It was not only the absence of the likable, 
the brave, the inspiring. It was not as simple as 
ordinariness, or mere indistinguishability. He 
was distinguishable. With relentless self- 
interest, he made himself impossible to forget 
and impossible to pity. He followed patients 
and staff from room to room, cornered house- 
keepers mopping floors and maintenance men 
hovering with wrenches. In a voice between a 
sandblaster and a just-unclogged drain, he 
would list and list and list the details of the 
car he did not have (Mazda Miata), the house 
he could not own (in Hawaii or Disneyland), 
the girlfriends he had not found (blonde). 
There was never reciprocity in the conversation, 
no inquiry outward or capacity to see beyond 
his yearnings. A therapist could grasp these 
yearnings as poignant, even endearing. But they 
were not the greater part of him. 

The greater part of him was kinetic and 
unpredictable, an electric toy after someone 
has poured water on the wires. He was pub- 
licly impulsive and immature, holding a knife 
to his chest in traffic. He was filled with vio- 
lent and vocal sexual fantasies. He attacked 
other patients deliberately. He refused Co 
shower. The cats behind the food building, 
advanced diagnosticians, saw him coming and 
spread their fur. 

It was Monday. It had rained all weekend 
and a lunar eclipse was on the horizon. The 
mute woman who kept the bulletin board had 
written, in her usual capital letters: THIS IS 
HOSTAGISM. The week before, her message 
had been: ARISTOTLE AHOY. 

He sat next to me in the day hall during the 
morning meeting. A large, very simple woman 
limped by. There was a nasty and uncreative 
exchange. "You're always whining, you fat pig!" 
"Look in the mirror when you say that!" "Look 



yourself!" Then it exploded. I |^^^^ 
saw it in slow magnification; ^^^^^ft 
my patient hurtling past ^^^^^^ft 

me — actually over me — onto ^^^^^^| 
her. Spit and nails flew. They ^^^^^^H 
were split apart by the nurses ^^^^^^| 
(always, the nurses), and sent ^^^^^^| 
to separate rooms. \ 1 y patient ^^^^^^| 
wept for himself. He could ^^^^^^| 
never remember who the vie- ^^^^^^H 

tim was. ^^^^^^| 

The meeting continued. A ^^^^^^| 

nurse asked whether anyone ^^^^^^| 
had ideas about how to ^^^^^^| 

decrease the assaults on the ^^^^^^| 
unit. "Easy," said someone in ^^^^^^H 

a bowler hat. "Kill the one ^^^^^^| 
who always starts ^^^^^^H 

There it was. Everyone ^^^^^^| 
knew whom he meant. The ^^^^^^H 

more socialized among us ^^^^^^| 
weren't free to think it out ^^^^^H 
loud — education forbade us. ^^^^^^| 
But my patient had united ^^^^^^H 

both sides of the floor. The ^^^^^^| 
man had made a profession ^^^^^^J 
of loathsomeness. It may have ^^^^^^| 
had to do with a broken brain ^^^^^^| 

or early history, maternal ^^^^^^| 
deprivation, or a lack of mul- ^^^^^^| 
tivitamins. Wherever it came ^^^^^^M 
from, his blood was bad. ^^^^^^| 

A certain kind of thera- ^^^^^^| 
pist, someone hard at work ^HIH^I 
on a thoughtful book, might 
have talked about the impor 
tance of understanding this patient's need to 
make himself detestable. He would have 
reminded us that we endure difficult patients 
by knowing more about them than they know 
themselves. He would have wondered gently. 
observed the patient with interest, attended 
with diligence. He might have pointed out 
some poignant detail of self to evoke sympa- 
thy. He would have cautioned the rest of us 
not to let our emotions interfere with our 
duty. Then he would have glanced at his 
watch, realized the time, nodded his head 
courteouslv, and left the locked unit. It is one 



24 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



and a just-unclogged drain, he would list and list and 
ar he did not have, the house he could not own. 




thing to grasp a patient theoretically. It is 
another to endure him in real time. 

I imagined the fight again — it could have 
been any of the daily fights he found himself 
in, but this last one was closest to memory 
and closest literally to me. The large, simple 
woman, who had few words and even fewer 
known thoughts, passed by. Insults flew. He 
hurled himself at her. But the staff did not 
come running. Instead, she drew up and hit 
back. She returned every punch. She was larg- 
er and stronger than he was. She spoke for all 
of us. No one stopped her. 



My imaginings gave shameless and unattrac 
tive satisfaction. Everyone deserves treatment; 
we are not allowed to refuse it. But in the world 
of humans tending other humans, there are 
some patients who make us want to deliver per- 
sonal justice. Personal justice is against the oath 
of good care and intention, against all training, 
and of course, against the law. It is unprofes- 
sional and unphysicianly. But in our worst 
moments, we can dream about it. ■ 

Elissa Ely '88, a lecturer in psychiatry at HMS, is ako 
a commentator for National Public Radio. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 25 




Physicians can learn to respond effectively when patients lose 



Every field manages anger in its own way. In the law or 
professional wrestling, anger is generally treated as a valuable 
commodity. In medicine, it is almost always seen as unwelcome, 
signaling a disruptive or dangerous breach in the doctor/ 
patient relationship. So instead of acknowledging the emotion, 
patients and doctors often collude in avoiding the issue — 
sometimes to the detriment of their working relationship. 



26 HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 







their patience 6j John G. Gunderson 






fDICAL 



crises can often transforn 
anger, which temporarily 



Doctors may face less anger than other pro 
fessionals because patients usually have at least 
a superficial sense that they're not supposed to 
be angry with their doctors. Often patients look 
up to the physician as someone whose motives 
are benign, from whom they can expect to 
receive relief from their suffering. Because we 
doctors share the patient's image of ourselves as 



beneficent authorities, we are often poorly pre- 
pared for encounters in which patients direct 
anger at us. Many of us feel that we're on the 
front lines doing good things for people, and we 
expect people to respect, if not laud, our 
motives. So, when our good intentions generate 
anger, we sometimes feel misunderstood, unap- 
preciated, hurt, or even angry ourselves. Since 



Explosion Control 

Tips for handling your patients' anger 



1 . Notice when a patient seems 
angry, then bring it up. This 
direct approach may uncover 
important information. 

2. When a patient appears to 
be angry or is behaving angri- 
ly help him or her acknowl- 
edge and verbalize that anger. 

3. Validate the reasons for 
a patient's anger. This helps 
reduce feelings of being disre- 
spected, ignored, and helpless. 



4. When you are scared, 
consider saying so. Efforts to 
assert control can make the 
situation worse. 

5. When a patient angers you, 
wait until you have had a 
chance to cool down and 
compose your thoughts 
before reacting. 



•it 



'#, 







28 HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



feelings of fear or helplessness into feelings of 
allows people to think they're taking charge. 



these feelings are discordant with our profes 
sional self image, our reflex is to avoid them and 
the circumstances that prompt them. 

Patients may find many occasions to feel 
angry with their doctors. The physician's words 
or actions may have left the patient feeling bul- 
lied, neglected, or unheeded — perhaps because 
the physician has indeed been oblivious to the 




patient's concerns, or because the patient is 
hypersensitive in ways that the doctor has little 
reason to suspect. Medical crises can often 
transform feelings of fear or helplessness into 
feelings of anger, which temporarily allows peo- 
ple to think they're taking charge. This is true 
not just for patients; family members may dis- 
place dissatisfaction or rage at the patient onto 
the doctor. 

Patients may manifest anger as impatience, 
rudeness, lateness, missed appointments, non 
compliance, or uncooperativeness. Sometimes 
the patient's anger will be direct, which is easier 
to respond to than indirect anger. If things heat 
up, anger may lead to the physician being threat 
ened with legal action — or even physical harm. 

Do Ask, Do Tell 

Whatever the reason — the desire to adopt the 
moral high ground, or perhaps a discomfort with 
emotion — physicians often respond to a patient's 
anger with avoidance. This strategy is, unfortu 
nately, the least productive. The best immuniza 
tion against this potentially vicious cycle is 
curiosity. If your patient becomes angry, you'll 
handle yourself and the situation more comfort 
ably and effectively if you become attentive and 
inquiring rather than injured. This may be easier 
said than done, but it's well worth the eflort. 

I often encounter anger in my work as a psy- 
chiatrist diagnosing and treating patients with 
borderline personality disorder. If a patient's 
anger arises because of insensitivity on my part, 
that dynamic is important to acknowledge and 
explore with the patient. Often the anger will 
occur because the patient is carrying around a 
lifelong grievance that is repeatedly bruised by 
situations that most people would find innocu- 
ous. Most people don't want to go through life 
being angry, so I tend to view this grievance as a 
kind of handicap that the unfortunate person 
carries through life. 

The key here is that if you don't ask, you won't 
know. So perhaps the most important principle 
is to notice when a patient seems angry, then 
bring it up. This direct approach is often dis- 
arming and may uncover information that you 
have been missing. Consider an instance in 



lELPIbJG 



patients realize that they 
their sense of potency or 



which you enter the examination room and 
notice that your normally affable patient 
appears tight-lipped. Wanting to avoid upset- 
ting the patient further, you proceed to do your 
best job, perhaps a little more meticulously and 
deliberately than usual. The patient leaves man- 
ifestly less happy than before. 

Now let's rerun the tape. You come in and say, 
after you've noted the patient's demeanor, "I'm 
not sure, but you seem upset or frustrated." The 
patient now responds, "You know, you came in 
late this morning. I'm sorry to complain, but I'm 
supposed to be somewhere after this appoint- 
ment, and I was worried that I wasn't going to be 
finished on time." Now you're dealing with accu- 
rate information, and you can go a long way 
toward correcting the problem. An easy apolo- 
gy — "I'm sorry, I do my best to be punctual, but 
sometimes..." — reestablishes an alliance and pre- 
pares you to be sensitive to this issue should it 
recur. I would add that doctors should not 
assume that habitual lateness is acceptable to 
their patients. 

All the Rage 

You may not be the only one who gets better 
information if you point out to patients that 
they seem angry. Many people have difficulty 
recognizing or acknowledging their own anger. 
Such people are greatly handicapped because 
they can't use anger to protest on their own 
behalf. You are doing them a service if you can 
identify the feeling for them and help them to 
acknowledge it. (This is not, by the way, the 
same as urging people to express their anger 
indiscriminately.) Knowing one is angry and 
being able to say so are generally adaptive capa- 
bilities that we take for granted. 

By recognizing that someone is angry, not only 
do you help sort out the facts of the situation, 
but you also take the first step toward resolving 
the anger. Validation is the key, for angry people 
don't feel the least bit better when their anger 
isn't taken seriously. You can acknowledge that 
someone may have a good reason for feeling 
angry without turning the situation into a judi 
cial proceeding. You might say something like, 
"Wow. I didn't suspect that you would feel so 



strongly about my unfortunate choice of words!" 
This is not an admission of harmful intentions; it 
simply recognizes the patient's discomfort and 
opens the way to talking through what hap- 
pened. Insofar as you dismiss or minimize a per- 
son's anger, you will escalate it proportionately. 

This principle holds true even when a patient 
becomes agitated or threatening. The instinct is 
often to threaten right back, saying, for example, 
"If you keep this up any longer, I'll have to call 
security." This may work if security has a rapid 
response time. Failing that, you are likely to be 
better served by an approach that seems coun- 
terintuitive but can often be more effective — a 
little like leaning downhill while skiing. 

Threatening behavior can arise from a 
patient's effort to gain control of an overwhelm- 
ing situation. A sense of being unseen, helpless, 
or persecuted usually underlies the behavior. 
Addressing these underlying feelings can go a 
long way toward defusing the situation. Yalidat 
ing the anger, even of someone threatening, can 
reduce that person's sense of being disrespected, 
ignored, and helpless. 

The next step may be even less obvious, but it 
can be critical. If the person is scaring you, sim- 
ply say, "You're scaring me." Helping patients 
realize that they are able to scare you is usually 
reassuring to their sense of potency or agency — 
exactly what they believe they have lost — and it 
opens up options for a dialogue about how to 
de-escalate the situation. It is generally safer — 
and more useful — to tell someone you're scared 
than to try to assert control. 

Clear and Present Danger 

The most uncomfortable I have been with an 
angry patient was many years ago when I was 
interviewing an inmate at Bridgewater State 
Hospital, the Massachusetts correctional facility 
where potentially dangerous people charged 
with a crime receive psychiatric evaluations. The 
patient got agitated; I got scared. I didn't see any 
way to push the security button without lunging 
past him. Someone passing by happened to look 
in and, perceiving my state of anxiety, entered 
the room. This interruption did not upset the 
patient; he too was relieved, having felt trapped. 



30 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



are able to scare you is usually reassuring to 
agency — exactly what they believe they have lost. 



Since then, I've been very quick to tell angry peo- 
ple that they're frightening me. It may be that I've 
just been lucky, but I have yet to see a patient 
who was not reassured by this message. 

In a threatening situation, of course, a 
patient needs some kind of containing or coer- 
cive action. The most dangerous state of affairs 
is one in which the balance of power is ambigu 
ous. Unless it is possible to establish immedi- 
ately and beyond doubt that the situation is 
secure, the preferred strategy remains acknowl 
edgment of the mutual problem and then, per 
haps, negotiation. 

In the Eye of the Storm 

There is no avoiding some patients' anger if you 
cannot or will not do something they want you 
to do, or if you must propose that they do some 
thing against their wishes. When you come to 
this kind of impasse, the temptation may be to 
deliver an ultimatum: "It you won't come to your 
appointments on time, I won't continue treating 
you." Or, "If you don't stop using cocaine, I'll 
have to refer you elsewhere." Although such ulti- 
matums may lead to the relief associated with 
the loss of a troublesome patient, it's worth 
thinking about whether the ultimatum is likely 
to help that patient. Rather than changing the 
behavior in question, the net effect may be that 
the patient leaves treatment or moves on to 
another clinician. 

When you find your patient's behavior to he 
intolerable, or if the patient is asking you to do 
something that you cannot do, it is always more 
effective to phrase the problem in terms of your 
own inability to meet the patient's perceived 
needs or demands. For example: "You find it 
hard to keep your appointments and I can see 
how you would want me to be more accommo- 
dating, but I just don't have the flexibility to be 
available on that basis." 

If a patient is doing something harmful, such 
as abusing cocaine, rather than threatening to 
refer the patient — as if the next doctor would 
accept such a referral — I would simply say, "I 
believe that my efforts are futile and, worse yet, 
the appearance of treatment perpetuates a sham 
that I fear may be harmful to you." 



Another response might be: "I know you 
would like me to prescribe narcotics for you, 
and I certainly don't want you to be in pain, but 
I don't feel able to do that without jeopardizing 
my professional pride and reputation." A patient 
might ask for a letter claiming an injury that you 
cannot diagnose. Here you might say, "I would 
like to help, but I couldn't look myself in the mir- 
ror if I did that." In any of these cases, you are 
not implying that your patient is demanding, 
conniving, or criminal, but rather affirming your 
wish to help and stating that the action request- 
ed is not something you believe would help 
them or that you would feel right about doing. 

Ol course, you may reach a point at which 
unreasonable requests — or provocative behav- 
iors — tempt you to respond with anger. In such 
situations, temporary avoidance is usually the 
better part of valor. Here it's best to wait a 
while, perhaps until the next time you meet, 
when the iron is, so to speak, cold. Then the 
opener might be something like, "You might 
have noticed that I got quite upset about what 
occurred. Had you expected me to react that 
way?" Then you might tell the patient that you 
got angry and clarify what it was that triggered 
your anger — whether you felt misunderstood, 
exploited, devalued, or ridiculed. Delay is valu- 
able because it gives you a chance to think 
through your response, allowing you to phrase it 
clearly and in a way that is in the patient's best 
interest. Ignoring the anger can lead to a false- 
ness in the working relationship and a recur- 
rence or escalation of the request that is not in 
anyone's best interest. 

It is unusual for any long term relationship to 
be Iree of angry feelings, even in the idealized 
and professionally constrained setting of a doc- 
tor's office. And it is common for people to 
believe that the anger should be neither felt nor 
expressed — especially toward those whose help 
they are seeking. The basic tools for dealing with 
anger are to recognize and validate the feeling, 
to express regret, and, if the interaction is scary, 
to say so. ■ 

John G. Gundcrson '67 is director of the Ambulatory 
Personality Disorder Service and Psychosocial Research 
Program at McLean Hospital in Belmont, Massachusetts. 






TELL ME THE 





ara-rramea pnysicians recall some or rneir mcKiesT cnnicai encounrers 





STRONG MEDICINE 



I WAS A THIRD-YEAR FAMILY PRACTICE RESIDENT, AND HE WAS A THUG, 
my senior in years, height, muscles, tattoos, and pockmarks. 
I was afraid he was going to beat me up. 

His lovely pregnant wife and two beautiful children were 
my patients. I had delivered their younger daughter while 
he was in prison for drug possession and theft, and he had 
recently gotten out of prison again on the same charges. 
I had just finished seeing his wife for a prenatal visit and 
needed to confront him about his irresponsible behavior. 
I walked him down a hospital corridor and spoke softly 
about how wonderful his family was, how they needed him, 
and how he needed to take care of them. I was afraid he 
was going to beat me up. He didn't. He listened carefully, 
nodded, and quietly thanked me. He was there for his son's birth a few months later and stayed out of prison. When I fin- 
ished my residency, he gave me a present. He had used a wood router to carve my name into a two-by-four. That nameplate 
is displayed in my office as I write this, as it has been displayed in my various offices for the past 20 years. 

— A family physician from Seattle, Washington 



32 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 




The Power of Babble 

A FRESH-FACED THIRD-YEAR STUDENT, I HAD BEEN ASSIGNED FLY ON THE-WALL STATUS 

during a rotation in community medicine. The setting was small-town America. My 
preceptor, Dr. S., was in solo general practice in his hometown, and he was caring for 
many patients who were aging along with him. 

Fannie came in with her list. Dr. S. introduced me, sat down at his desk, and began 
listening to her litany. He took a few notes and then abruptly got up, excused himself to 
Fannie, and asked me to take over while he saw another patient. He returned a few 

moments later and resumed his seat. Fannie didn't miss a beat but swiveled to face him and continued her relentless barrage. 

Suddenly, to my horror, Dr. S. began to slide slowly down in his chair, lower and lower, until he slipped off the chair completely and 

disappeared out of sight into the kneehole of 

his desk. Unfazed, Fannie followed him, lean 

ing forward to maintain the same personal 

space between them, all the while moving 

resolutely from item to item on her list. 
Finally, they reached the limits of what 

could be communicated by body language — 

he, huddled under the desk with his arms 

protectively cradling his head upon his knees, 

and she, precariously leaning over the desk, 

peering intently at him. She finally paused. 

"Dr. S.," she said plaintively, "sometimes I feel 

you don't take me seriously!" "Sure I do," he 

replied, "but sometimes I get overwhelmed." 
Relief washed over me as I realized that 

nothing could shake the bond between 

these two, who had known each other all of 

their lives — not even honesty. 

— A rheumatologist from Richmond, Virginia 




Last Rites 

I SAT IN A FAMILY MEETING WITH THE 

husband and grown children of a patient 
who was dying of lymphoma. The husband, a 
retired social worker, had worked profes- 
sionally with many dying patients. I began to 
ask him, "How can I be most helpful to you?" 
but even before I finished the question, I 
could see the rage building in his face. 

"Don't give me any of that palliative care 
crap," he thundered. "Just do your job!" 
Fhere was a heavy silence in the room. His 
daughter murmured, "Oh, Dad, you don't 
need to yell." But obviously he had needed to 
yell. And at that moment I needed to sit 
silently with them, red faced. 

The next morning I learned that the 
patient had died during the night and that 
the husband had apologized for his behav 
ior. He had appreciated our care. I, of 
course, wondered whether I should have 
been the one to apologize. 
— A palliative care physician from Chicago, Illinois 



STEEL 
YOURSELF 

WHEN VINNIE PULLED A HUNTING 

knife out of his satchel and started 
stabbing the air, it was about 7:35 
in the morning, five minutes into his 
therapy session. We were in my 
small office down a long and at that 
hour largely uninhabited corridor. 

Vinnie's sidekick of many years, Rhon- 
da, had just made off with his modest cash 
reserves. Vinnie had taken pains to show her 
where the stash was and to warn her not to touch 
it. He knew that she was sinking further and further 
into cocaine abuse. How could he not have known 
what she would do as soon as she had the chance? 

Fresh from discovering the inevitable, Vinnie was in 
a rage that played right to the last row of the balcony. 
I was, however, front row center and far closer to the 
knife than I cared to be. My efforts to calm the storm 
were unavailing. I lowered my voice, softened my 
demeanor, and watched Vinnie veer closer and closer to 
the edge of his psychic stage. Then from somewhere in my 
consciousness, I recalled how one of my teachers had said 
that a patient's agitation can be made worse by a physician's 
steadfast calm, for the patient is left to feel abandoned to the inner 
storm. Feeling like an utter fool, I lifted halfway out of my chair and 
started yelling what a horrible thing Rhonda had done. The effect was 
nearly instantaneous. Vinnie deflated into his chair, let the knife dangle, 
and started talking a modicum of sense. A moment later, I observed, in my 
usual voice, that the knife made me uncomfortable, and Vinnie quickly put it awa> 

— A psychiatrist from Cambridge, Massachusetts 



Whoops a Daisy 



SOMETIMES A THREAT IS NO! 

from violence but from love. 
He was a homeless man who 
heard voices and came to the 
clinic to see me each week 
in an effort to sort them out 
Money for cigarettes and food came 
from cans he collected from the trash 
before dawn. He was too suspicious to 
accept government support. There was no 
one for him but me. 

A lew months into his visits, something strange began to 
happen. Fifteen minutes before each appointment, an 
arrangement of flowers arrived in my office. There were roses 
and birds of paradise, snapdragons and exotic things. The 
delivery boy staggered under the size; the bouquets were so 
large you couldn't see around them. There was no card. 

I knew the sender and why he sent them. It was gratitude and 
a bribe, his heart for all to see. But it was all wrong. For one 
thing, he had no money. For another, we were a clinic for the des- 
titute; floral arrangements flew in the face of poverty. And tech- 
nically — which was to say, in terms of psychiatric technique — I 
couldn't accept his gifts: it would have been like accepting his 




erotic proposal. But refusing 
them would have been like 
breaking his heart. The day he 
showed up with a crystal bud 
vase, action was required. He 
came into the office and put 
the vase on the desk. I closed the 
door and stood next to it. 
"Mr. X," I said, "about the 
vers." I felt like I was drawing 
blood for the first time. 
"You like them?" he asked. "They're no big 
deal." (I love you, only you.) 
They're beautiful. But you can't send any more." 
"Don't you like 'em?" (What did I do wrong?) 
"Of course. But you can't send them." 
"How come?" (Don't I mean anything to you?) 
Here's where wisdom should have spoken — part frankness, 
part empathy, an expensive explanation that left him informed 
but cared for. "It's against the rules," I said. It was the cheaper 
road to take. His face fell. "So no more flowers," I added. 

"Against the rules," he said. He thought for a sad moment, 
then brightened. Now he understood. "No more flowers," he 
said. "Sure. Next week, a fruit basket." 

— A psxehiatrist from Boston Massachusetts 



NOT ON THE SIDE OF THE ANGELS 



EVEN SOME 25 YEARS AGO, LYNN, A ONCE-PROUD 

city north of Boston, had become a haven 
for people down on their luck and the crimi- 
nally inclined. It was in that rough community 
that a young black man had gotten romanti- 
cally involved with the white girlfriend of 
a member of the motorcycle gang Hell's 
Angels. In retribution, gang members 
stormed the man's apartment and proceeded 
to carve him up, along with his friends. 
When I arrived on the scene late that after- 
noon, the carnage was incredible; some 
were dead while others were suffering from 
large stab wounds from knives violently thrust 
through bones, ribs, and even sternums. 
The victims were transported to the hospital, where Hell's Angels were camped outside the entrance, astride idling 
motorcycles and with menacing stares. They would sometimes rev their engines or race their bikes around the perimeter of 
the hospital; a few times they even tried to storm it. The police seemed powerless, though they were eventually able to pro- 
vide us safe passage through the gauntlet of bikers. Because charges had not yet been filed, the bikers were acting within 
their legal rights, thus threatening the integrity of the hospital and the safety of all of us. 

Inside, the stabbing victims and their families could hear the constant revving of motorcycle engines. Once the 
patients were stabilized, we began to plan their transfer to safer institutions. Not surprisingly, no other hospital was 




34 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 




YOU'VE COME 

A LONG WAY, BABY 

ONE DAY EARLY IN MY PEDIATRIC INTERNSHIP, I NOTICED THAT SOMETHING WAS 

blocking access to my next patient, who was waiting for me on the 

exam table. I looked down to find the patient's baby sister sleeping 

soundly in her carseat. Smiling, I grasped the handle and gently 

^^ swung the carseat a couple of feet to the left. But the baby 

was not buckled in, and the handle was not locked into place. 
As soon as I lifted it, the handle rotated against the seat, launch- 
ing baby sister into flight. Three feet later, she landed face first in the 
hallway, right in front of my preceptor. 

The baby would prove to be fine, and her mother — remarkably — for- 
gave me. But I'll never forget that horrible feeling of watching a baby fly 
through the air. It reminds me to take nothing for granted in any clinical 
encounter— not even my ability to avoid dropping the patient. 

— A pediatrician from Baltimore, Maryland 



eager to accept them. Finally, we moved two 
of the more stable patients under police pro- 
tection and made arrangements for the rest. 
The remaining patient, who was the principal 
focus of the Hell's Angels' wrath and whose 
injuries were the most severe, could not be 
moved. I insisted on police protection for him 
around the clock. 

The Angels eventually disappeared to their 
country hideout and the patient was safely dis- 
charged. I continued to see many of the victims 
in my Salem office, including the man who had 
been the main target. He and his family were 
grateful, and I felt a bond with them. I could not 
hope to understand the experience of being 
young, poor, and black, but I had certainly 
shared their fear. Even so, the striking contrast 
between their terror in the besieged hospital 
and my escape each day to a comfortable 
home in a white, suburban neighborhood will 
haunt me forever. 
— A thoracic surgeon from Danvers, Massachusetts 



Loose Lips 



AT FIRST I VIEWED HIM AS A GOOD CASE NO, A GREAT CASE, WITH 

a social history hardly ordinary. Felony armed robbery was 
his specialty, his life sentence having been imposed after a 
third conviction. He told countless stories — of prison life, of 
stickups and con-jobs, of raps beaten. He had been released 
to die in our hospital when his prison doctors certified that 
he would never beat this rap — pancreatic cancer. 

Initially I was eager to hear the stories, to be invited into 
his dark world. But I grew sick of it, found the sociopathy 
invidious, this patient reprehensible. It wasn't merely that I 
didn't like him. I began to abhor him, much as one abhors a 
wife beater or child molester. And until that point in my 
professional life, I had never hated a patient. 

When he became delirious from pain medication, he 
began to babble unchecked about the unsolved crimes for 
which he prided himself, delighting especially in the mid- 
night heists at the turnpike gas stations with a partner still 
not apprehended. Yet incredibly, his babbling would abrupt- 
ly cease whenever he sensed the presence of a cop — a caution 
not lost upon the police frequenting his bedside. 

Here I was then, with a human being I detested, oath- 
bound to care for him, to attend to his suffering, to respect 
his confidences. Imagine my ambivalence when the police 
asked me to wear a wire. 

— A cardiologist from Augusta, Maine 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



35 




on 



A surgeon trained 

in the secret 

maneuvers of the CIA 

recounts his role in 

the Korean War 



BY THOMAS G. PARKER 





"■^TT^^. I THE WINTER OI I95O, DURING MY SECOND Yl U* 01 SUR 

I ^^L gica] training at Massachusetts Memorial Hospital 

^^L in Boston, 1 volunteered to join the Air Force m^\ 

^B soon received orders to report for active duty once 

— H_ _I_ ^ my training year ended. Then, unexpectedly, one of 

my surgical professors, Reginald Smithwick '25, summoned me to his 

office — an unusual event of either great or terrible implication. 

When the Korean War erupted in the summer of 1950, just five years 
had passed since the end of World War II. The United States found itself, 
once again, in an urgent military situation and faced with an armed forces 



SECRET AGENT MAN: 
Thomas Parker '49 
went from a surgeon- 
in-training to a CIA 
recruit in the early 
days of the agency. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



37 




doctor shortage. Younger physicians in the reserves 
were called up to active service shortly after the onset 
of battle, and the Doctor Draft Act quickly became law. 

When I received the summons to my professor's 
office, I could not have guessed that I was about to be 
swept up in these events. As it turned out, a fellow 
academic surgeon in Washington, DC, had made an 
inquiry of Smithwick: Did he know of any young sur- 
geons who might be interested in special, classified 
duty with the Department of Defense? Well, I thought, 
when Smithwick made his pitch, why not? I was 25, 
single, and adventuresome. 

The next day I met with a Dr. Gibson. The former 
gastroenterologist displayed a sharp sense of humor 
and yet a businesslike demeanor. Gibson revealed few 
details except to inform me, rather cryptically, that I 
would be taking on a medical, classified assignment 
with the Department of Defense and that he would be 
in touch shortly. I was instructed not to mention our 
meeting to anyone, and we exchanged no written infor- 
mation beyond names and phone numbers. One call 
later, roundtrip plane tickets arrived for a prearranged 
rendezvous with Gibson in our nation's capital. 

Upon my arrival in Washington, Gibson drove me 
to a Navy building on E Street, which he identified as 
Central Intelligence Agency headquarters. I had never 
even heard of the CIA. Over the next 48 hours I under- 
went exhaustive testing, orientation, interviews, poly 



graphs, and a medical checkup. I received repeated 
reminders not to reveal my new affiliation to anyone, 
family included. 

Not long afterward, my Air Force assignment mys 
teriously changed, and I received new instructions to 
report to what turned out to be a mythical Pentagon 
office. This "office" was actually just a mail drop. The 
change in orders was my last written communication. 
After that, we conducted all business by telephone. 

In the summer of 1951 I did indeed report to a new, 
secret life in Washington, where "the Company" made 
things move quickly and smoothly. The perks includ 
ed a lieutenant colonel equivalent GS 19 salary grade: 
the rather princely sum of $1,800 monthly. This was no 
small comfort to a guy who had previously been earn 
ing S25 a month. 

The CIA, then in existence as an agency for only two 
years as the successor to the Office of Strategic Ser- 
vices, labored under huge growing pressure from the 
Korean War. Many Ivy League graduates were secretly 
recruited, but I was the only doctor there as far as I 
could tell. For three months, we underwent eight 
hours of training a day in security, strategies, geopolit 
ical issues, clandestine techniques, and assorted spy 
tricks. We learned how to set up a safe house, create a 
mail drop, and carry out a "dead drop," whereby we hid 
a document at an unmonitored site for later pickup by 
another agent. We were taught how to copy a key on a 



learned to shoot a ,45-caliber revolver and a 
30 mm carbine. I also learned six different 
ways to kill a man using only my bare hands. 



highly 



wet blotter, how to ascertain whether a door had been 
opened by closing a paper match in its hinge, and how 
to malinger. X ly favorite malingering sleight called for 
us to hide some venapuncture or animal blood in the 
mouth, then, when a pressing situation arose, to writhe 
dramatically and spew blood on the nearest enemy. 

This was serious business with a brij 
motivated crowd. And, of course, the curriculum 
marked a dramatic change from my surgical training, 
with its emphasis on learning to help people rather 
than to deceive them. We were eventually team tested 
in downtown Washington; one final drill tasked us to 
obtain a certain document from a particular commer 
cial office. We were warned that the CIA would deny 
any knowledge ol us if we got caught. The police 
arrested one team but its members were quickly 
released by a federal judge's mysterious order. 




1 volunteered to go to Korea for one year because 
assignments at other stations usually lasted two years. 1 
was sent to Fort Benning in Georgia for a fortnight, 
where I had the dubious honor of participating in the 
jump school, hand to-hand combat, and weapons man 
agement courses — not what I had envisioned as part of 
my medical mission. I persuaded the authorities that 1 
did not need the full tour, yet I still learned to shoot a 
.45-calibcr revolver and a 30 mm carbine, to carry a 100- 
pound backpack, to eliminate an enemy with a kmte by 
thrusting rather than slashing, and to make a proper 
landing after bailing out of an airplane. I also learned six 
different ways to kill a man using only my bare hands. 

At Fort Benning, a soldier or two always seemed to 
be clinging helplessly to the jump towers at some high 



spot, with parachutes drooping against the 250 loot 
tall structures. They were the unlucky souls who had 
drifted the wrong way when released from the free fall 
training towers. A rescue sergeant always seemed to be 
on his way up to help disentangle the men. No one 
earned merit points for tower hanging. 

One of my most memorable moments there 
occurred as I was walking under the beginners' jump 
platform, where soldiers were engaged in making 
their wry lirst jump. They wore parachute harnesses 
rigged to cables that rolled them downhill to a soft 
landing. On one end of the platform stood a lew 
young servicemen shouting at the top of their lungs 
to the sergeant clown below, "I'm a coward, a chick- 
en shit coward! 1 balked, I didn't jump!" They kept 
repeating this mantra, their humiliating penalty Un- 
hesitating to obey a jump command. 

A Long Way from Home 

Just before Christmas of 1951, I arrived 
at a U.S. Air Force base in Atsugi, Japan, 
w here the CIA occupied a high-security, 
isolated compound that housed uni 
formed personnel from all the services. 
Although no signs announced a CIA 
presence, the diversity of personnel, mix 
of uniforms, presence of civilians and 
women, and absence of Japanese per 
sonnel suggested that it was not just 
an American Air Force base, as the 
entrance sign claimed. 

The Korean War was the lirst "inter 
national" conflict sanctioned by the 
I nited Nations. More than 20 countries sent person- 
nel, all of whom served under the United Nations flag. 
American troops rubbed shoulders with Greek, Bel- 
gian, Turkish, British, French, and Australian soldiers. 
The Swedes ran a hospital; the Danes, a hospital ship. 
In reality, however, it was mainly an American effort, 
as evidenced by some 37,000 Americans who died 
there. It was a unique war waged by diverse, free men, 
and we learned much from each other. 

\ ly new- station was located just outside of Ptisan at 
a Korean hot spring resort, which had been comman- 
deered and now bore an Air Force "cover." Its tiny 
medical unit had been started by a bewildered Navy 
doctor who was all too happy to leave. With it came a 
fine Korean lad, Lee Won Woo, then 23 years oi age. 



COMBAT READY: 
Facing page: 
Parker (right), 
his aide, Lee 
Won Woo (cen- 
ter), and a 
corpsman pose 
in front of an 
ambulance 
scrounged off 
an Army Motor 
Pool sergeant. 
Left: Parker 
stands at the 
ready to treat 
casualties of 
parachute 
training jumps 
gone awry. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



39 





was called on the field phone by a young 
CIA case officer asking how many morphine 
syrettes it would take to kill someone. 



without whom I could not have done much. He was 
reserved at first, but we soon earned each other's 
respect. We were together about 20 hours a day for a 
full year, and we found that we shared a remarkably 
similar philosophy even though we came from hugely 
different societies and faiths. 



Und 



ercover 



Med 



icine 



My job was to provide medical support to everyone 
from household staff to covert agents operating in 
North Korea. We supported a number of clandestine 
training camps headed by Republic of Korea (ROK) 
senior officers. We all were feeling our way and it 
was uphill work. One night I was called on the field 
phone by a young CIA case officer asking how many 
morphine syrettes it would take to kill someone who 
was going to be buried alive; the doomed man had 
been convicted of being a double agent. We guessed 
six, and the traitor was "mercifully" buried with 
morphia. I also witnessed an ROK commander, in 
view of all his trainees, formally execute a double 
agent with a pistol shot to the head. This was all a 
long way from New England and I lost 20 pounds in 
the first two months. 

"The Company" had full access to everything, and 
my support from Washington was superb. More than 
once I had to use a medical hot line (my pseudonym 
was Andrew J. McElfresh, taken out of the Dublin 
phone book). I had to deport an older full colonel who 
was behaving dementedly, a Navy lad who was gay, 
and a lieutenant colonel who fractured his femur dur- 
ing a jump he had been expressly warned not to make. 

I also rendered medical care to ROK commandos, 
who were sometimes injured while blowing up 
bridges or making parachute landings. They arrived by 
truck, helicopter, or ocean luggers in strange ways and 
at strange times. We had dispensaries at our U.S. and 
ROK training sites, where we treated common ail- 
ments. Major trauma required a hospital and I had 
top-secret authority to admit anyone — including 
Koreans — to any U.S. facility. At odd hours, this took 
some convincing of medical duty officers at U.S. Army 
hospitals and U.S. Navy hospital ships. None of these 
facilities was near the combat zone. 

Once I did an appendectomy on the commanding 
officer of an island training camp. I operated out in the 
open sun with the assistance of instruments boiled by 
wood fire and a corpsman. Thank goodness, the spinal 



worked. When I revisited that camp, you would have 
thought I was the president of Korea. 

Spies Awry 

The intelligence community included some fascinat- 
ing people. One U.S. Air Force sergeant had a personal 
cadre of about 20 Korean men whom you did not want 
to cross. They manned two eight-ton native fishing 
boats off the eastern coast of the South China Sea. 
Below deck, they hid a destroyer's firepower with 
recoilless 80 mm cannons and weapons of all kinds. 
They would sail north, change the flag at the 42nd par- 
allel, and proceed to cut telephone cables and blow up 
bridges. Then there was a British Major Kitkat (clear- 
ly not his name), who would appear with a wounded 
man or two (we never asked questions) and then dis- 
appear, only to repeat his mission in a month or so. 

But sometimes events did not go as planned, such as 
when a CIA case officer and his pilot went down in a 
"sterile" — that is, unidentifiable — C-47 airplane deep 
inside China. They were on a top-secret mission to 
pick up a defecting communist Chinese official as part 
of Operation Skyhook, a highly classified CIA maneu 
ver used to snatch people from the ground by slow, 
low-flying aircraft. 

In this maneuver, a ground team would stake two 
20- foot-tall "goalposts" joined by a nylon snatch line. 
They would then affix the snatch line to a harness that 
the escapee wore while standing with his back to the 
flight pattern. The plane would fly in low and slow 
enough so that its grasping, self- tightening hook 
would sweep between the poles, snag the lift line, and 
whisk the escapee into the air. To prevent G forces 
from tearing the man apart, the system relied on a 
sensing winch spooled with 800 feet of nylon rope of 
good stretching capacity, which immediately reeled 
out against the resistance. Then it would slowly 
reverse and the man would be reeled up into the plane. 

Following the crash, the 21 year-old CIA case offi- 
cer was a prisoner for 20 years in China. On my 
return to the United States, I had the awkward duty 
of informing his widowed mother that he was dead. 
We did not know, in fact, whether he was dead or 
alive or even what had happened. We simply stuck to 
our cover story of a plane going down in the South 
China Sea. Until the officer's capture was known, a 
U.S. submarine dutifully waited near a previously 
designated Chinese land point on the last day of each 



40 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 







month, as per the agent's Escape and Evasion Plan — 
another CIA specialty. When President Nixon 
opened diplomatic relations with China, the case 
officer was finally released. He lives today in Con- 
necticut with a Chinese wife — truly a fine man and 
unsung hero, who has never written about the mis- 
adventure that cost him 20 years of freedom. 

Close Encounters 



Part of my job was to care for U.S. personnel who were, 
at times, a rowdy bunch. Their complaints ranged 
from lacerations to fractures to sexually transmitted 
diseases. One of my great triumphs was getting a 50 
by 25 foot clinic built on the nearby United Nations 
Civil Assistance Command compound by providing 
an Army quartermaster major with off the-record 
treatment for gonorrhea. I then traded two cases of 
medical Scotch for a winterizing kit, which allowed us 
to run the facility year-round. I was also able to find a 
Korean doctor and nurse to staff the clinic for Korean 
civilian patients, whose only access to medical care 
had been at the beleaguered local facilities. 

I traveled to campsites mosdy by bad dirt roads and 
wore out two jeeps during my tour. As we had lost some 
personnel in guerrilla actions, my superb aide, Lee Won 
Woo, always wore a sidearm, and 1 always carried a 
9 mm Beretta in a hidden shoulder holster. And we 
certainly did not want to travel at night. In fact, the 



SPY KIDS: Parker 
unlocks a gate to 
the fenced-in clinic 
he helped cobble 
together to treat 
neglected Korean 
civilians, especially 
children. 



United Nations train making the journey between 
Pusan and Seoul was frequently targeted by guerrilla 
snipers during its overnight run. Passengers were actu 
ally assigned weapons for the trip, and each numbered 
seat had a designated 30 mm rifle stored in a wall rack. 
The train had three open, sandbagged stations at the 
front, middle, and rear, each equipped with a manned 
.50-caliber machine gun. I sometimes felt as though I 
had stumbled onto the set of a Hollywood Western. 

One afternoon, some 40 miles from Pusan, Lee Won 
Woo and I were driving home from a camp. We came 
upon a small farming community with a large U.S. mil 
itary truck and two GIs surrounded by 50 or more 
angry Koreans. One distraught citizen cradled a three 
year old child in his arms. Woo ordered the people to 
step back and told them that I was a doctor. When I 
confirmed that the child was dead, the four of us sud- 
denly found ourselves in a menacing situation as the 
crowd closed in tighter around us. Without warning, 
Woo flipped out his .45 caliber revolver and fired two 
rounds into the air. The crowd backed away as I hus- 
tled the two GIs into our jeep. Woo rode shotgun 
while I drove until we reached a safe distance. I have 
no doubt that, tragically, the child had darted out into 
the path of the truck. I am indebted to my courageous 
aide, as were the unlucky corporal and private. 

Coming In from the Cold 

By the time I returned to the States after my year ot 
service in Korea, the CIA had matured amazingly. And 
it now has a complex medical support system. But we 
helped give it a jump-start way back when. I was 
indeed happy to have survived this powerful experi 
ence and to resume my surgical training in August 
1953. I was newly married and the future had never 
looked brighter. 

Fifty years ago, I signed a contract, a copy of which 
I never owned, promising neither to publish nor to 
reveal any information about the CIA. After recently 
receiving clearance from the CIA allowing this article 
to go to press, I am delighted to be able to share my 
memories of this extraordinary adventure with my old 
friends and colleagues, who thought I was just behav- 
ing peculiarly back in 1951. ■ 

Thomas G. Parker '49 practiced general and thoracic surgery for 
34 years in San Mateo, California, and was associated with 
Stanford Medical School. 



a • a « » . « 

- . . • 1 1 



f 



UTT'M 




Ground Zero 

A member of one of the Disaster Medical Assistance 
Teams reflects on the despair — and lessons — of the 
September 1 1 tragedy, by J AY J. SCHNITZER 



ITALY WAS MY INTENDED DESTINATION ON 
September 11. But instead of flying out of 
Logan Airport to attend a medical confer 
ence in one of the world's most tranquil 
settings, I found myself driving down to 
New York to help deal with the aftermath 
of one of humankind's crudest disasters. 

That morning, I had been sitting in my office at 
Massachusetts General Hospital when a staff mem 
her poked her head in the door to say that a plane 
had just crashed into one of the World Trade Center 
towers. Within moments, everyone in the office w as 
glued to the surreal images on our television screen. 
By noon, we had received word that all four Boston 
based Disaster Medical Assistance Teams were to 
he deployed to New York. And by six that evening, 
we were on our way. 

With our caravan of rented vehicles — flying, of 
course, was not possible — nearly 70 of us — doc- 
tors, nurses, paramedics, emergency medical tech 




nicians, security personnel — headed toward Stew 
art Air Force Base near Newburgh, New York, to 
await further instructions. We armed at two in the 
morning and bedded down for the remainder of the 
niijht on assigned cots in a large hangar. Tensions 
were running high, and we all desperately wanted 
to do something, no matter how small, to help 
those who had been hurt. 

At daw n. we awoke surrounded by nearly 3,000 
personnel, both civilian and military, from through 
out New England, who had arrived overnight in 
preparation lor further deployment. The disaster 
response leadership at first believed that the World 
Trade Center would be a mass-casualty scenario. 
They had decided to set up additional emergenc) 
personnel at the air force base to staff a triage and 
evacuation hospital. Tragically, we would soon real 
ize that the World Trade Center was a mass-fatali- 
ty disaster. Within the first few hours of the attack, 
all of the initial sun ivors had been triaged to New 
York City and surrounding hospitals. Those who 
could be treated were; the rest had been killed. 

The Walking Wounded 

Within 24 hours, it was obvious that the disaster 
response teams would not be needed to treat 
wounded patients from the site. Rumors flew, and 
we feared that we would soon be disbanded and 
sent home, ha\ing done nothing. As a physician, I 
have seldom felt so helpless and frustrated. Yet we 
soon learned that we were to provide emergency 
on site medical care to the rescue workers — the 
firefighters, police officers, and ironworkers who 
were frantically digging through the acres of smol 
dering rubble in lower Manhattan. Suddenly we 



MAKESHIFT MEDICINE: The Disaster Medical 
Assistance Teams treated 4,215 patients on site. 



WINTER 2002 • HARVARD MEDICA1 A1UMNI BUUETIN 



43 




RING OF HOPE: Medical workers set up five stations around the perimeter of the "pile" to care for rescue workers. 



had a new mission. We were deployed to New York City 
on Thursday at five in the morning — the first Disaster 
Medical Assistance Team to arrive. 

We were initially assigned to Chelsea Pier, where we 
spent the day with frustratingly little to do. By Thursday 
evening, however, a group of us were moved downtown 
in police vans to a location much closer to Ground Zero 
to set up the first medical station. Between midnight 
and six in the morning, we set up our station in the 
courtyard of a community college. It was pitch dark, the 
rain was pouring, and the wind blew fiercely, but we felt 
httle of it; finally, we were doing something. Although our 
mission had now become one of support rather than res- 
cue, we embraced it eagerly. 

By dawn on Friday, our unit was up and running, and 
we had taken over medical care of the rescue workers 
from volunteers at the local high school a block away. Our 
team of approximately 30 people worked the first shift in 
the tent, and we subsequently organized a series of rotat- 
ing eight-hour shifts with three other teams. 

The New York City Fire Department and Emergency 
Medical Services then decided to place advance teams 
closer to the actual site, and five medical stations were 
set up in a perimeter around the "pile," as the site of the 
Twin Towers had come to be known. Some were in tents 
and one, surreally, in what had once been a delicatessen, 
with the neon "pizza" sign still flickering. 

Most of our patients were the "walking wounded" — 
rescue workers with eye irritations, foot injuries, upper 
respiratory symptoms, and minor wounds. We also saw 
patients with serious medical problems or trauma. Each 
shift, we transported to local emergency rooms three to 
six rescue workers with complaints of chest pain and 
shortness of breath. Many of these were retired person- 
nel with cardiac histories who, despite warnings not to 
do so, came to work on the pile anyway. We also treat 
ed a small number of victims of falls, explosions, flash 
fires, and burns. All of the workers were exhausted and 
subjected to enormous, unabated stress. Within two 
weeks of the first medical station's becoming opera- 
tional, disaster response teams had cared for 4,215 
patients, as many as 600 a day. 



As a hospital-based surgeon, I found myself deeply 
impressed by the skill and cool-headedness of the para- 
medics and emergency medical technicians. I saw them 
manage difficult airways, stabilize patients, and set up 
intravenous fluids under the most trying of circum- 
stances. Unflappable — despite the poor lighting, drop- 
ping temperatures, rain, wind, fire, smoke, and even 
falling debris — they set an example for all of us. 

At Med Station 2, the grim odor of decaying flesh that 
permeated the air offered a constant, sickening reminder 
of the deadly toll. This station was set up in the lobby of 
the American Express Building, next to which sat a large, 
white tent that served as a temporary morgue. This facil- 
ity was staffed with morticians who had been brought in 
from around the country to deal with the overwhelming 
number of corpses and body parts being recovered. 

During a quiet spell on one of my shifts, I spoke with the 
police sergeant stationed at the entrance to the mortuary 
tent. A stoic, middle-aged man, he had been preparing to 
head home after working the night shift when the first 
frantic 911 calls started coming in over the police radios. He 
had rushed to the scene to help extricate as many people as 
possible before the towers collapsed. He then dug in the 
ensuing rubble for many more hours straight through 
until, exhausted, he finally returned home briefly. There, 
he had broken down and cried before returning to his 
beat, now one of the largest disaster sites in history. 
He had lost friends and colleagues, whose remains, no 
doubt, passed by him as they were transported to the 
makeshift mortuary, where he stood mournful guard. 

On Hallowed Ground 



Even as we focused on the task of treating the thousands 
of patients who streamed through our stations, it was 
difficult not to be overwhelmed by the hellish devasta- 
tion that lay right outside our tents. Nothing in my life's 
experience — not my surgical training, not the time I 
spent operating on children caught in the crossfire in the 
Gaza Strip, not even the tele\ision news coverage of the 
Twin Towers disaster — could have prepared me for what 
I witnessed at Ground Zero with my own eyes. 



44 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



"Even as we focused on the task of treating the thousands 
of patients who streamed through our stations, it was 
difficult not to be overwhelmed by the hellish devastation 
that lay right outside our tents. -jay j. schmitzer 



My first night there, I stood at the edge of the pile and 
gaped at the staggering destruction and carnage before 
me. The skeleton of the buildings, now iconic in every 
one's mind, loomed over the acres of smoldering ruins. A 
100 foot-tall communications antenna that had once 
perched atop one ol the towers, a quarter mile high in the 
sky, now lay directly in my line of sight at ground level. 

My first stunned impression was that this could not 
possibly be real; surely, this was an incredible Hotly w ood 
set. The dazzling lights that Con Edison had set up on 
high poles illuminated the scene with an otherworldly 
intensity that reminded me of a night game at Fenway 
Park. Yet the brightness seemed grotesquely incongruous 
with the mass grave that lay beneath the rubble \^ I 
stared, mesmerized, I realized it was all too real. 

We were standing on hallowed ground, and everyone 
treated the site with the respect it deserved. Firefighters 
gingerly picked their way through the smoldering, smok 
ing pile of twisted steel, debris, dust, and human remains. 
Rescue workers dug gently with hand tools — no hea\y 
equipment was allowed at this stage — in the desperate, 
vanishing hope that they might find a survivor in the rub 
ble. I watched a nurse trying to console one of the rescue 
dogs, who was visibly distraught. 

As physicians, we, too, sometimes shared the hopes — 
and disillusionments — of the rescue workers. Shortly 
after midnight a few days into our mission, I was the 
supervising medical officer on the overnight shift at Med 
Station 2. 1 found myself standing at the windows, staring 
at the rubble yet again. The night was cool and cloud}-; the 
drizzle earlier in the day had stopped, and everything glis- 
tened wetly in the artificial light. Suddenly my paramedic 
team leader ran over to me. "Someone thinks they saw a 
hand move on the east side of the pile — they want a sur- 
geon on-site stat!" I grabbed my emergency pack and 
raced to the area where the Urban Search and Rescue 
Team was operating. There the team leader stood, looking 
dejected. "It was only a piece of metal stripping moving in 
one of the holes," he said. "We sent in the dogs and the 
fiberoptic scopes, but no one was down there." For a few 
precious minutes, hope and excitement had flared; then 
instantly everyone dissolved into despair again. 



We remained in the rescue phase of the operation for 
several more days, although hope was quickly fading. It 
was not until our team departed, ten days after the 
attacks, that the mission officially became one of recovery. 

Out of the Ashes 



The events ol September 11 will no doubt mark for this 
generation what the John F Kennedy assassination rep 
resented for mine; a tragic watershed moment. But that 
day has also given those of us in the medical profession 
valuable insights into our future. We learned that our 
country's disaster response system works. It is solid, but 
it is not pertect, and we must incorporate what we have 
learned into future planning. 

We also learned that flexibility is essential. Plans and 
situations change rapidly, unexpectedly, and frequently. 
We have to be able to adapt moment by moment. We 
learned as well that job descriptions are often irrelevant 
in the face of disasters. As a surgeon, I spent more time 
in a hard hat and work gloves than I did in a scrub cap 
and sterile O.R. glowv 

And yet I saw that we, as physicians, can do a great deal 
to help people, even under austere circumstances and 
with imperfect tools. At Ground Zero, we had no x-ray 
machines, laboratory facilities, or fancy diagnostic equip 
ment but nonetheless managed to do good work just by 
relying on clinical skills and judgment. 

Perhaps most important of all, I saw that people's 
capacity for good is still greater than their capacity for 
evil. The heroes of this tragic story were the firefighters, 
police officers, and ironworkers. The images of these men 
and women gently, somberly, and respectfully removing 
human remains day after day — often to the point of col- 
lapse — will stay with me forever. It was my profound 
privilege to work with these extraordinary people, who 
stood as a constant and much-needed reminder of human 
decency, compassion, and sacrifice. ■ 

Jay J. Schnitzcr '83 is a pediatric surgeon at Massachusetts 
General Hospital and a member of a Boston Disaster Medical 
Assistance Team. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 



45 



SPLENDOR ON THE GRASS: The marble used in the construction 
of Harvard Medical School's new home in 1906 was originally intended 
for the New York Public Library. The marble was rejected as being not 
white enough, however, and the contractors lor Harvard Medical School 
acquired it at a bargain price. In the end, more exterior marble was used 
for the Quadrangle buildings than had been used in Boston in 20 years. 




46 HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 




BUILT TO 




IN THE MARBLE 

SPLENDOR 

OF BUILDING A, 

THE SIXTH 

ADMINISTRATIVE 

HOME OF 
HARVARD 

MEDICAL SCHOOL 
HAS PROVED TO BE 

ENDURING 

BY NORA N. NERCESSIAN 



T 

N MAY 1899, THE PRESIDENT OF HARVARD 

University, several members of the Har- 
vard Corporation, and a few medical facul- 
ty members arrived at the home of John 
Collins Warren on Beacon Hill to discuss 
^™^^^^M one of the most ambitious schemes ever 
proposed by an academic group with depleted resources: 
the construction of a grand new medical school with its 
own hospitals, estimated to cost millions. The proposed 
plan aimed not only to relocate Harvard Medical School 
from Boylston Street to Longwood Avenue, but also to 
enlarge the size of its facilities and their outreach in an 
unprecedented manner. ■ Warren, whose ancestors had 
played a pivotal role in the founding and growth of the 
School since 1782, would not compromise. For him and the 
handful of faculty members committed to the move, bring 
ing research and hospital facilities to one centralized space 
was imperative because, they believed, proximity between 
laboratory bench and patient bedside was needed 
more than ever. ■ The medical faculty, intensely com- 
mitted to the new plan on Longwood, was able to secure 
the means to purchase a 26- acre plot that would accom- 
modate the Medical School, the Dental School, and two 
hospitals on the Ebenezer Francis estate. Despite the Uni- 
versity's conservative financial policies, by June 1900, 
Harvard President Charles Eliot had accepted the idea of 
the School's relocation to the Francis estate. ■ The great 
financier J. Pierpont Morgan provided funding for the 
administration building and two of the four laboratory 
buildings. By most accounts, the first meeting between 
Morgan and the faculty members lasted only five minutes. 
Frederick Shattuck, the Jackson Professor of Medicine, 
would later write that Morgan strode into the office, 
looked at the architectural plans lying on the table, and 
said, "Those are good-looking buildings. How much will 
the administration and the two adjoining buildings cost?" 
Without receiving a definite answer, he added, "Send me 
your architects. Good morning, gentlemen." 



ANATOMY OF 

'A' BUILDING 



i - 





48 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 




Elevator 



Vestibule 



Committee Room 




PLAN INTO 
ACTION 

A. The site of the new 
buildings in 1903. 

B. The plan of the first 
floor of Building A 
in 1906. 

C. At the time of the 
dedication in 1906, 
Henry Pickering 
Bowditch (seated), the 
first full-time professor 
of physiology in the 
United States, and John 
Collins Warren, the first 
Moseley Professor of 
Surgery. 

D. Construction in 
progress in June 1904. 

E. William Lambert 
Richardson, the first 
HMS dean to occupy 
offices in Building A. 







MEETINGS 'ROUND THE 



In 1 950, Mrs. Robert De 
W. Sampson, a great- 
granddaughter of Benjamin 
Waterhouse, presented 
HMS with a grandfather 
clock. Waterhouse, one of the 
founders of Harvard Medical 
School, had originally received the 
clock as a gift in 1790. 

The Waterhouse Clock was 
installed on the first floor of Building 
A in the Faculty Room, which was 
renamed the Waterhouse Room. 
Because the clock was too short to 
allow for its running a full year on 
one winding, the bottom of the 
clock was cut out and holes were 
punched in the floor through which 
the 50-pound weights could sink. 

In December 1950, the Univer- 
sity marshal instituted the annual 
winding ceremony at the School's 
traditional Christmas party. The cer- 
emony continued into the 1960s 
when medical students and their 
teachers would gather at a party 
in the Waterhouse Room and take 
turns in raising the heavy weights 
that kept the grand clock ticking. 




WIND-UP JOY: From 1950 
into the 1 960s, HMS students 
and faculty members would 
wind the Waterhouse Clock at 
the annual Christmas party. 



An Oasis in Marble 

Land was first broken for the buildings 
in September 1903. By then, several 
plans had been considered. But the plan 
finally adopted had four large buildings 
facing an open Quadrangle, with the 
administration building majestically at 
the head. A corridor running through 
the basement of the administration 
building, but on the first floor of the oth- 
ers, connected all of the buildings. 

Crowds gathered to watch the con 
struction of the buildings as they slowly 
transformed the swamp of the Francis 
estate into an oasis of classical grandeur. 
Besides the architectural style and mas- 
sive size of the new structures, the mate 
rial out of which they were built set them 
apart from their environment. In the 
original plan, the buildings were to be 
constructed of modest brick with gran 
ite trimmings. But one of the bidders, 
Norcross Bros. Co., proposed to substi- 
tute luxurious marble in place of lime 
stone for the exterior of the buildings. 
The marble Norcross offered had origi 
nally been intended for the construction 
of the New York Public Library, which 
was in progress in 1902. But because the 
marble was not totally free of color, it had 
been deemed "unsuitable" by the archi 
tects of the library and therefore became 
available at a discounted price. In the 
end, more exterior marble was used for 
the buildings around the Quadrangle 
than had been used in Boston in 20 years. 

Long before his dedication speech, 
President Eliot had chosen names for 
each of the five Quadrangle buildings. 
His choice of Hippocrates and Galen for 
the administration building inevitably 
placed a special significance on the 
building and a moral responsibility on 
those who would inhabit it and shape its 
mission in the years to come. Yet the 
building came to be widely known by 
the letter "A," as designated in the origi 
nal architectural drawings. 

The Students' Path 



When the new buildings finally opened, 
the 304 medical students enrolled were. 



by their sheer numbers, the main occu 
pants of Building A, a fact that was evi 
dent in the amount of space devoted to 
them. The first floor housed the Students' 
Smoking Room, the Students' Reading 
Room, and the Alumni Room, which 
served as a club room for both alumni and 
students. Within the Reading Room was 
the Library, where a gift from alumni 
formed the nucleus of the collection and 
contained works of daily use by students. 
The Library had started with plans to 
become "more perfect than any in Amcri 
ca, as soon as circumstances will permit," 
and contained the Faculty Collection — 
publications and manuscripts of all the 
professors who had ever taught at the 
School. The three rooms ottered the only 
common space tor students in the Quad 
rangle until L927, when Yandcrbilt Hall 
began operations and provided a com 
mon room for student use. 

Two marble staircases, then as now, 
led to the hall on the second floor, 
which was devoted to lecture halls and 
classrooms. At the head ot the staircase. 
the student would tind two classrooms, 
each with two raised platforms: one 
equipped with a blackboard where the 
instructor stood, the other lor lanterns. 



Projection was on the wall over the 
blackboard or on screens that unrolled 
from a canopy near the ceiling. 

To the right of the classrooms was the 
Amphitheater for Surgical Lectures. 
The lower level of this room, where the 
lecturer stood, was connected with a 
Preparation Room, so that specimens 
could be transported directly from the 
museum above on movable tables. Also 
on the second floor was a large lecture 
room for Obstetrics, Theory and Prac 
rice ol Medicine, which was connected 
to two Preparation Rooms. 

A Heavenly View 

From the teaching area on the second 
floor, two staircases led to the wist 
expanse of the Grand Hall, which, with 
its galleries, occupied almost half ol the 
vertical elevation ot the administration 
building, projecting a space altogether 
different from the floors below That 
effect was achieved through the translu 
Lent vault that ran across the width ol the 
building, the glass openings all around 
the vault, and the windows in each alcove 
ol the two galleries and the Grand Hall. 
Together, they allowed light to penetrate 



the building, transforming the interior 
of the entire upper half of the building 
into an almost otherworldly space. 

Here, on the third floor, and spreading 
over the two galleries above, was the 
Warren Anatomical Museum, with its 
extensive collection ot 11,000 medical 
instruments and anatomical and patkv 
logical specimens. The museum was a 
major teaching resource for students and 
faculty. Established in 1847 with the per 
sonal collection of the first John Collins 
Warren, the Hersey Protcssor ot Anato 
my and Surgery from 1815 to 1847, it 
chronicled changes in medical education, 
practice, and instruments. Upon retire 
ment, Warren donated approximately 
600 items to the University, along with 
an endowment ot railroad stock worth 
$5,000 tor the museum's continued 
maintenance and improvement. 

The medical faculty and physicians 
across the country sent many more spec- 
imens. Most were preserved in large glass 
jars, from which they could be removed 
lor study or demonstration. But topping 
the list were the remains of the former 
I [ersej Professor himself, John Collins 
Warren, who had willed that alter his 
postmortem his "bones he carefully pre- 




VIEW LOOKS MARBLEOUS: Vista from the Greek portico of Building A after the construction of Avenue Louis Pasteur. 



WINTER 2002 • HARVARD MEDICAL ALUMNI BULLETIN 51 



served, whitened, articulated, and placed 
in the medical College near my bust; 
al lording, I hope, a lesson useful, at the 
same time, to morality and science." 

Activities in the Warren Anatomical 
Museum slowed down during World 
War I. New activities were restricted, 
expenses curtailed as much as possible, 
and the museum closed to the general 
public. At the end of the war, the muse- 
um received a large num 
ber of specimens from the 
battlefield, showing the 
effects of bullet wounds 
to the head and the 
lesions of "gas gangrene." 
It also became a reposito- 
ry of war memorabilia, 
including a German bomb 
that had fallen in a 
French hospital that had 
been staffed by the Har- 
vard men of Base Hospital 
No. 5. 

More relics would arrive 
after the end of World War 
II, during which the School 
prepared for possible Ger- 
man attacks. A number 
of faculty members were 
charged with security 
duties. Particular care was 
taken for the Library where the stacks 
were to be fitted with a fire door. In addi- 
tion, a large number of security officers 
were posted around the buildings, which 
were better lit to protect against "possi- 
ble enemy damage." 

Changes in the Air 

Although all of Building A was trans 
formed during the course of the twenti- 
eth century, the first areas to undergo 
change were the first and second floors, 
due to the expansion of the Library in 
1928. In its new and expanded setting 
on the second floor, the Library became 
the repository of memorabilia that con- 
nected the School with world events. At 
the entrance to the Ernst Room, on the 
opposite side from the Civil War Tablet, 
hung a large bluish- green slate listing 
the names of HMS alumni and faculty 




RADICAL FORUM: 

During the spring of 

1 969, strike posters 

plastered the columns 

of Building A. 



who had died in the service of their 
country during World War I. Another 
war memorial was designed in 1947, this 
time for faculty members and alumni 
who lost their lives in World War II. 

The changes brought about a shifting 
of the space dedicated to students. In 
1928, space was set aside as a women's 
rest room, which, the dean informed the 
department heads, any secretaries or 
technicians were wel- 
come to use. Later, fol- 
lowing the admission of 
the first group of women 
as students at HMS in 
1945 — which occurred 
after almost a century of 
debate — a Women Stu- 
dents' Room was added in 
the basement. 

Transformations in the 
Warren Anatomical Muse- 
um had started by the 
mid- 1940s, when offices 
were added to the Grand 
Hall and when the 
expansive skylights had 
been covered as a war- 
time security measure. In 
later years, new teaching 
methods would diminish 
the museum's usefulness 
as a primary teaching resource. Gradually, 
in part because of increasing demands 
within the School for more research, 
classroom, and administrative space, 
some of the museum collections were 
put into storage and eventually trans- 
ferred to other institutions. The muse- 
um survived, in different forms and 
shapes, for more than 90 years in Build 
ing A. It would reemerge in 2000, only 
in part, in the Warren Museum Exhibi 
tion Gallery in the Francis A. Count- 
way Library of Medicine. 

In the late 1960s, Building A, like the 
School and the country at large, wit- 
nessed the dilemmas and pain caused by 
dramatic events — the Civil Rights Move 
ment, the Women's Movement, and the 
Vietnam War. Just as the building had 
been a repository of the events of the two 
world wars earlier, it was transformed, 
for a short time, into a forum where stu 



dents expressed their \iews on medical 
ethics, the curriculum, and politics. 

The Gordon Hall of Medicine 

In 2002, nearly 100 years after the origi 
nal marshland was transformed into a 
premier center of medical education and 
research, the administration building has 
been rededicated as the Ellen R. and 
Melvin J. Gordon Hall of Medicine. The 
skylight running across the east-west 
axis of the building has reopened to the 
light after more than half a century of 
obscurity. The area beneath the skylight, 
once the Grand Hall, has been rededicat- 
ed to the Academy, a program aimed at 
advancing the School's teaching mission. 

As the Academy retrieves the teaching 
mission of Building A, the landscape 
around Gordon Hall resounds with 
preparations for the new interdiscipli- 
nary science of tomorrow. The buildings 
surrounding Gordon Hall on the origi- 
nal Quadrangle, now called the South 
Quad, will be renovated to accommo- 
date the new ventures inspired by the 
rapid pace of molecular biology. 

Beyond these, the Quadrangle has 
already begun to expand on Avenue 
Louis Pasteur, north of the parapet walls 
and beyond the Circle of Tugo. From 
Gordon Hall, the \ista toward the Fens 
will soon include the new research facil- 
ities of the North Quad, where ground 
was broken in February 2001 — nearly a 
century after a similar ceremony took 
place on the other side of the Circle of 
Tugo — and which, HMS Dean Joseph 
Martin explained, "will embody the spir- 
it of cooperation" with the communities 
surrounding Harvard Medical School. ■ 

Nora N. Ncrccssian, PhD, is assistant dean of 
alumni affairs and special projects at HMS. This 
article is excerpted from her recent hook, 
A Legacy So Enduring: An Account of the 
Administration Building at Harvard 
Medical School from Its Foundation to 
Its Rededication as the Gordon Hall 
of Medicine. A limited number of copies of the 
book are available from the author; please con 
tact her at 617-432-1560 or nora_nerccssian@ 
hms.harvard.edu. 



52 



HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 



THE HALLS OF 

MEDICINE 




nrii 



111 M AMli "/Vf ! 
j , Ml WW 111 I 



-:frftft» 



<i 






:' ; ' 



,.;1 ■- ' ■ 



I /HO 



f 

ll'l . I 



>- ,m ^. r 



I 




AN INSIDE LOOK 

A. The Library on the first floor of Building A in 1923. 

B. A view of the Warren Anatomical Museum in 1906. 

C. The marble staircase leading to the second floor of Building A in 1906. 

^\ i i i r ^# m 



W 



m 



te 






;4> s lP!iiifiiJBS 



-'*: 









p.\ * . M 






fell 

1' "JS 




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CLASS NOTES 



NEWS ABOUT ALUMNI 



Donald W Bkkley 

I 937 "After 67 years of active prac- 
tice, I made my last two house 
calls on August 31, 2001. My 
oil ice then became "The Cedar 
\ alley Hospice Home." 

Paul H. Liljestrand 

"I finally retired at the age of 90 
from the Hawaii Chamber of 
Commerce Charitable Founda- 
tion awards committee, which 
is still gi\ing away money origi- 
nally raised to fight the 1898 
plague. Because of the way the 
fund was set up, contributions 
continued to be made long after 
the plague was eradicated. Mil- 
lions of dollars were later trans- 
ferred into a fund for the health 
of the people of Oahu. For 50 
years, I've been able to go to 
monthly committee meetings 
and help give away the money." 

Conrad M. Riley 

1 938 "I went on a Yale- and Har- 
vard-sponsored cruise to 
Greece and Turkey last April 
and found myself the only 
octogenarian there. My wife 
and I enjoyed every minute." 

Carl F .. Ta ylor 



1 94 1 "I continue to teach and do 
field research — August in 
Tibet, October in Peru, and 
two field trips to the Indian 
Himalayas — my main source 
of healing after the death of 
my wonderful wife, Mary." 

James F. Kreisle 



1 942 "Natalie and I visited Cully 
Cobb and his wife, Cathy, at 
their home on Old Hickory 
Lake near Nashville in Octo- 
ber 2001. Both are fine. Cully 
is active in sailboat racing." 

Robert J. Glaser 



Watson School of Biological 
Sciences, a degree-granting 
education program of the Cold 
Spring Harbor Laboratory, at 
a convocation celebrating the 
Ill-year history of science 
education at the laboratory. 
Glaser was recognized for his 
effective leadership as director 
for medical science and 
trustee of the Lucille P. 
Markey Charitable Trust. 

Tewis A. Barn ess 



1 944 was honored at a celebration 
tribute held in Tampa, Flori- 
da, in February. The ceremo- 
ny, which honored his com- 
mitment to medical educa- 
tion for almost six decades, 
included a day and a half of 
scientific symposia. Until 
1988, Barness was founding 
chairman of the Department 
of Pediatrics at the Universi- 
ty of South Florida School 
of Medicine. 

Chester C. dAutremont 

"In March I became the grand- 
father of triplets, all doing 



very well. Their mother, my 
daughter Sloan, is the other 
MD (pediatrics) in the family. 
Bragging rights to being first- 
born go to the girl. The other 
two are boys." 

Fvan Calkins 



1945 has opened a rheumatology 

consulting practice in associa- 
tion with his daughter, Joan 
Calkins, a pediatrician and 
pediatric rheumatologist. The 
office is located in Hamburg, 
New York, the village where 
the Calkins family has lived for 
the past 40 years. "It is a joy to 
work together," Calkins writes. 

Stuart H. Q. Quan 

has been honored with the 
first Recognition Award of the 
Northeast Society- of Colorec- 
tal Surgeons. Quan is an inter- 
nationally recognized expert 
in malignancies of the colon 
and rectum. Upon retirement 
after 51 years of senice to 
Memorial Sloan- Kettering 
Cancer Center, Quan is emeri- 
tus attending surgeon at 



'43B received an honorary Doctor 
of Science degree from the 




HARVARD MEDICAL ALUMNI BULLETIN • WINTER 2002 




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